PDF(Pubmed)
Abstract：
The clinical evolution of patients infected with the Severe Acute Respiratory Coronavirus type 2 (SARS-CoV-2) depends on the complex interplay between viral and host factors. The evolution to less aggressive but better-transmitted viral variants, and the presence of immune memory responses in a growing number of vaccinated and/or virus-exposed individuals, has caused the pandemic to slowly wane in virulence. However, there are still patients with risk factors or comorbidities that put them at risk of poor outcomes in the event of having the coronavirus infectious disease 2019 (COVID-19). Among the different treatment options for patients with COVID-19, virus-targeted measures include antiviral drugs or monoclonal antibodies that may be provided in the early days of infection. The present expert consensus is based on a review of all the literature published between 1 July 2021 and 15 February 2022 that was carried out to establish the characteristics of patients, in terms of presence of risk factors or comorbidities, that may make them candidates for receiving any of the virus-targeted measures available in order to prevent a fatal outcome, such as severe disease or death. A total of 119 studies were included from the review of the literature and 159 were from the additional independent review carried out by the panelists a posteriori. Conditions found related to strong recommendation of the use of virus-targeted measures in the first days of COVID-19 were age above 80 years, or above 65 years with another risk factor; antineoplastic chemotherapy or active malignancy; HIV infection with CD4+ cell counts < 200/mm3; and treatment with anti-CD20 immunosuppressive drugs. There is also a strong recommendation against using the studied interventions in HIV-infected patients with a CD4+ nadir <200/mm3 or treatment with other immunosuppressants. Indications of therapies against SARS-CoV-2, regardless of vaccination status or history of infection, may still exist for some populations, even after COVID-19 has been declared to no longer be a global health emergency by the WHO.
摘要：
感染严重急性呼吸道冠状病毒2型（SARS-CoV-2）的患者的临床演变取决于病毒和宿主因素之间复杂的相互作用。进化到侵略性较小但传播更好的病毒变体，以及越来越多的接种疫苗和/或暴露于病毒的个体中存在免疫记忆反应，导致大流行的毒力缓慢减弱。然而,仍有存在风险因素或合并症的患者,如果患2019年冠状病毒感染性疾病(COVID-19),则存在预后不良的风险.在COVID-19患者的不同治疗选择中，病毒靶向措施包括抗病毒药物或可能在感染早期提供的单克隆抗体。本专家共识是基于对2021年7月1日至2022年2月15日期间发表的所有文献的回顾，这些文献旨在确定患者的特征。就存在风险因素或合并症而言，这可能使他们成为接受任何可用的针对病毒的措施以防止致命结果的候选人，如严重疾病或死亡。从文献综述中纳入了总共119项研究，从后验专家小组成员进行的额外独立综述中纳入了159项研究。在COVID-19的第一天发现的与强烈建议使用病毒靶向措施相关的条件是80岁以上的年龄，或65岁以上的另一个危险因素;抗肿瘤化疗或活动性恶性肿瘤;CD4+细胞计数<200/mm3的HIV感染;和抗CD20免疫抑制药物治疗。也有强烈推荐反对在CD4+最低点<200/mm3的HIV感染患者中使用所研究的干预措施或用其他免疫抑制剂治疗。SARS-CoV-2疗法的适应症，无论疫苗接种状态或感染史，对于某些人群来说可能仍然存在，即使在世界卫生组织宣布COVID-19不再是全球卫生紧急情况之后。
