Background

Respiratory syncytial virus (RSV) can be fatal in immunocompromised patients. Aerosolized ribavirin is used for treatment but it is costly, teratogenic, and inconvenient. We aimed to assess the outcome of oral ribavirin, with or without intravenous immunoglobulin (IVIG) for RSV in immunocompromised patients.

Methods

The medical records of moderate to severely immunocompromised patients with RSV infection in 2011-12 were reviewed. Severely immunocompromised patients were defined as (1) allogenic hematopoietic stem cell transplant (HSCT) patients <6 months after transplantation or beyond 6 months with >grade 2 GVHD and (2) lung recipients in the first year post-transplant or beyond one year with augmented immunosuppression. Moderately immunocompromised patients were (1) other solid organ transplant recipients, (2) patients with hematologic malignancies receiving chemotherapy, (3) allogenic HSCT patients >6 months after HSCT or with GVHD <grade 2, (4) autologous HSCT patients, and (5) patients with substantial endogenous or exogenous immunosuppression.

Results

Of 36 patients with PCR-proven RSV, twenty received oral ribavirin and were moderately to severely immunocompromised. The mean age was 58.3 years (range: 39-90); twelve were male. Underlying conditions were hematologic malignancy with or without HSCT (n=16), lung transplant (n=2), receipt of cytotoxic chemotherapy (n=2). The symptoms were cough (90%), fever (55%), and dyspnea (55%). The most common radiographic findings were patchy and nodular infiltrates and opacities. Seventeen patients were hospitalized, with seven admitted to the intensive care unit; two required mechanical ventilation. Fifteen developed RSV pneumonia or bronchiolitis. The mean initial duration of ribavirin treatment was 10 days (range: 5-11); four patients were re-treated. Eleven received a mean of 3.5 doses of IVIG. One developed hemolytic anemia and lactic acidosis. One died of complications related to acute graft-versus-host disease and leukemia; all others recovered clinically.

Conclusions

Despite not receiving IV ribavirin, no moderately to severely immunocompromised patients died of RSV infection. Oral ribavirin with or without IVIG is a reasonable treatment for RSV infection in immunocompromised hosts.

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