Outcome of SARS-CoV-2 infection among patients with common variable immunodeficiency and a matched control group: A Danish nationwide cohort study

Abstract

The risk of severe adult respiratory coronavirus-2 (SARS-CoV-2) infection and the course of the infection among individuals with common variable immunodeficiency (CVID) relative to the general population have been a matter of debate. We conducted a Danish nationwide study comparing the timing of SARS-CoV-2 vaccination, the risk of first confirmed SARS-CoV-2 infection, re-infection, and the outcome of infection among individuals with CVID relative to an age- and gender matched control group. Cox regression was used to calculate incidence rate ratios. The CVID patients received SARS-CoV-2 vaccinations earlier than those included in the population control group. Even so, the risks of both first infection and re-infection were increased among the individuals with CVID. The CVID group also had increased risk for hospital contacts due to SARS-CoV-2 infection relative to the general population. However, reassuringly, the risk of mechanical ventilation and death did not differ between the groups, but the numbers were low in both groups, making the estimates uncertain. Though this is the largest study to investigate the risk of SARS-CoV-2 infections and outcomes hereof among individuals with CVID relative to the general population, we cannot rule out minor differences in severity, which might only be detectable with an even larger sample size.

Keywords: clinical outcome; common variable immunodeficiency (CVID); inborn errors of immunity (IEI); severe adult respiratory coronavirus-2 (SARS-CoV-2); severe novel coronavirus 2019 (COVID-19).

Figure 1

Time to second and third SARS-COV-2 vaccination. Black lines: population controls, gray lines: CVID patients. Solid lines: second vaccination, dotted lines: third SARS-CoV-2 vaccination. Time starts on January 1, 2020 and ends on May 1, 2022.

Figure 2

Time to first and second positive SARS-CoV-2 test. Solid lines: first positve test, dotted line: second positive SARS-CoV-2 test. Black lines: population controls, gray lines: CVID patients.

Figure 3

(A) First hospital contact with COVID-19. Solid line: population controls, dotted line: CVID patients. Time starts on 1 March 2020. (B) Time to first hospitalizations with severe COVID-19, Solid line: population cointrol, dotted line: CVID patients. Time starts on 1 March 2020. (C) Time to hospitalization after the first positive SARS-CoV-2 test. Solid line: population controls, dotted line: CVID patients. Time starts on date of first positive SARS-CoV-2 test.