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SARS-CoV-2 infection has significantly contributed to morbidity and mortality in patients with primary humoral immunodeficiencies, such as those with X-linked agammaglobulinemia (XLA) and common variable immunodeficiency (CVID). Currently, there is insufficient data to determine if mRNA vaccination and/or previous COVID-19 infection confers protection against rapidly mutating SARS-CoV-2 variants in patients with primary humoral immunodeficiencies.
Common variable immunodeficiency (CVID) is a primary immunodeficiency due to selected genetic defects. This syndrome is frequently associated with non-infectious complications such as interstitial lung disease, enteropathy, autoimmunity and malignancies, with lack of isotype-switched B cells. B cell–activating factor (BAFF) is one of the TNF family members important for IgA class switching and plasma cell survival. Excessive levels of BAFF are found in CVID patients.
B-cell maturation antigen (BCMA) is a TNF family receptor that binds a proliferation inducing ligand (APRIL) and B cell activating factor (BAFF). BCMA is expressed by immunoglobulin secreting cells, but not other B cells, and supports their survival. Primary antibody deficiency (PAD) is the most common primary immunodeficiency and may lead to infection and complications including autoimmunity, enteropathy, lung disease, and malignancy.
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