Unit of Infectious Diseases, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III (ISCIII), 28041 Madrid, Spain
Pedro Pérez-Segura
Medical Oncology, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
Jesús San Román
Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
Juan Berenguer
Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), 28007 Madrid, Spain
Clinical Microbiology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
Pedro Pablo España
Pneumology, Hospital Universitario de Galdakao-Usansolo, 48960 Vizcaya, Spain
Ignacio Alberto Gómez-Centurión
Haematology and Haemotherapy, Hospital General Universitario Gregorio Marañón, 28007 Madrid, Spain
Juan María González del Castillo
Emergency Department, Hospital Clínico Universitario San Carlos, 28040 Madrid, Spain
Sarah Béatrice Heili
Intermediate Respiratory Care Unit, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
Francisco Javier Martínez-Peromingo
Department of Medical Specialities and Public Health, Universidad Rey Juan Carlos, 28922 Madrid, Spain
Rosario Menéndez
Pneumology, Hospital Universitario y Politécnico La Fe, 46026 Valencia, Spain
Santiago Moreno
Infectious Diseases, Hospital Universitario Ramón y Cajal, 28034 Madrid, Spain
José Luís Pablos
Rheumatology, Hospital Universitario “12 de Octubre”, Instituto de Investigación Sanitaria Hospital “12 de Octubre” (imas12), 28041 Madrid, Spain
Juan Pasquau
Infectious Diseases, Hospital Universitario Virgen de las Nieves, 18014 Granada, Spain
José Luis Piñana
Haematology and Haemotherapy, Hospital Clínico Universitario de Valencia, 46010 Valencia, Spain
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 3; 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 3 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.
