Persistent SARS-CoV-2 infection: significance and implications

Heather M Machkovech; Anne M Hahn; Jacqueline Garonzik Wang; Nathan D Grubaugh; Peter J Halfmann; Marc C Johnson; Jacob E Lemieux; David H O'Connor; Anne Piantadosi; Wanting Wei; Thomas C Friedrich

doi:10.1016/S1473-3099(23)00815-0

Persistent SARS-CoV-2 infection: significance and implications

Lancet Infect Dis. 2024 Feb 7:S1473-3099(23)00815-0. doi: 10.1016/S1473-3099(23)00815-0. Online ahead of print.

Affiliations

¹ Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA.
² Department of Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, CT, USA.
³ Department of Surgery, University of Wisconsin-Madison, Madison, WI, USA.
⁴ Department of Molecular Microbiology and Immunology, University of Missouri-School of Medicine, Columbia, MO, USA.
⁵ Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
⁶ Department of Pathology and Laboratory Medicine, School of Medicine and Public Health, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA.
⁷ Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA, USA.
⁸ Department of Pathobiological Sciences, University of Wisconsin-Madison, Madison, WI, USA. Electronic address: tfriedri@wisc.edu.

PMID: 38340735
DOI: 10.1016/S1473-3099(23)00815-0

Abstract

SARS-CoV-2 causes persistent infections in a subset of individuals, which is a major clinical and public health problem that should be prioritised for further investigation for several reasons. First, persistent SARS-CoV-2 infection often goes unrecognised, and therefore might affect a substantial number of people, particularly immunocompromised individuals. Second, the formation of tissue reservoirs (including in non-respiratory tissues) might underlie the pathophysiology of the persistent SARS-CoV-2 infection and require new strategies for diagnosis and treatment. Finally, persistent SARS-CoV-2 replication, particularly in the setting of suboptimal immune responses, is a possible source of new, divergent virus variants that escape pre-existing immunity on the individual and population levels. Defining optimal diagnostic and treatment strategies for patients with persistent virus replication and monitoring viral evolution are therefore urgent medical and public health priorities.

Publication types

Review