People who are immune-deficient/disordered (IDP) are underrepresented in COVID-19 studies. Specifically, there is limited research on post–SARS-CoV-2 infection outcomes, including viral persistence and long-term sequelae in these populations. This review aimed to examine the published literature on the occurrence of persistent SARS-CoV-2 positivity, relapse, reinfections, variant coinfection, and post-acute sequelae of COVID-19 in IDP. Although the available literature largely centred on those with secondary immunodeficiencies, studies on people with inborn errors of immunity are also included. PubMed was searched using medical subject headings terms to identify relevant articles from the last 4 years. Articles on primary and secondary immunodeficiencies were chosen, and a special emphasis was placed on including articles that studied people with inborn errors of immunity. The absence of extensive cohort studies including these individuals has limited most articles in this review to case reports, whereas the articles focusing on secondary immunodeficiencies include larger cohort, case-control, and cross-sectional studies. Articles focusing solely on HIV/AIDS were excluded. Scientific literature suggests that IDP of any age are more likely to experience persistent SARS-CoV-2 infections. Although adult IDP exhibits a higher rate of post-acute sequelae of COVID-19, milder COVID-19 infections in children may reduce their risk of experiencing post-acute sequelae of COVID-19. Reinfections and coinfections may occur at a slightly higher rate in IDP than in the general population. Although IDP experience increased viral persistence and inter-host evolution, it is unlikely that enough evidence can be generated at the population-level to support or refute the hypothesis that infections in IDP are significantly more likely to result in variants of concern than infections in the general population. Additional research on the relationship between viral persistence and the rate of long-term sequelae in IDP could inform the understanding of the immune response to SARS-CoV-2 in IDP and the general population.

中文翻译：

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陷入大流行的不确定性：回顾 COVID-19 感染对免疫缺陷人群的持续影响

在 COVID-19 研究中，免疫缺陷/紊乱 (IDP) 人群的代表性不足。具体而言，对 SARS-CoV-2 感染后的结果（包括这些人群中的病毒持续性和长期后遗症）的研究有限。本综述旨在审查已发表的有关 IDP 中 SARS-CoV-2 持续阳性、复发、再感染、变异合并感染和 COVID-19 急性后遗症发生情况的文献。尽管现有文献主要集中于继发性免疫缺陷患者，但也包括对先天性免疫缺陷患者的研究。使用医学主题词搜索 PubMed，以识别过去 4 年的相关文章。选择了有关原发性和继发性免疫缺陷的文章，并特别强调包括研究患有先天性免疫缺陷的人的文章。由于缺乏包括这些个体在内的广泛队列研究，本综述中的大多数文章仅限于病例报告，而关注继发性免疫缺陷的文章包括更大的队列、病例对照和横断面研究。仅关注艾滋病毒/艾滋病的文章被排除在外。科学文献表明，任何年龄段的国内流离失所者都更有可能经历持续的 SARS-CoV-2 感染。尽管成人 IDP 表现出较高的 COVID-19 急性后遗症发生率，但儿童中较轻的 COVID-19 感染可能会降低他们出现 COVID-19 急性后后遗症的风险。国内流离失所者中再感染和合并感染的发生率可能略高于一般人群。尽管国内流离失所者经历了病毒持久性和宿主间进化的增加，但不太可能在人群水平上产生足够的证据来支持或反驳这样的假设：国内流离失所者的感染比其他国家的感染更有可能导致令人担忧的变异。总人口。对 IDP 病毒持久性与长期后遗症发生率之间关系的进一步研究可以帮助了解 IDP 和普通人群对 SARS-CoV-2 的免疫反应。