Herpesvirus reactivation during severe COVID-19 and high rate of immune defect

Saade, A; Moratelli, G; Azoulay, E; Darmon, M

Objective: We assessed herpesvirus reactivation in severe SARS-CoV-2 infection. Methods: Retrospective study including consecutive patients admitted to an onco-hematology intensive care unit (ICU) for severe COVID-19. Replication of EBV, CMV, and HSV was evaluated. Competing risk analyses were used to assess the cumulative risk of viral reactivation, and time-dependent Cox and Fine and Gray models to assess risk factors for viral reactivation. Results: Among 100 patients, 38 were immunocompromised. Sixty-three patients presented viral reactivation (12% for HSV, 58% EBV and 19% CMV). Symptomatic patients received treatment. Overall cumulative incidence of viral reactivation was 56.1% [55.9-56.4] at 10 days. After adjustment, a preexisting hematological malignancy (sHR [95%CI]=0.31 [0.11-0.85]) and solid organ transplantation (sHR [95% CI]=2.09 [1.13-3.87]) remained independently associated with viral reactivation. Viral reactivation (P=0.34) was not associated with mortality. Conclusions: Incidence of herpesvirus reactivation in patients admitted to the ICU for severe COVID-19 was high, but rarely required antiviral treatment.