From the Guidelines
Immunocompromised conditions are primarily caused by disorders or treatments that weaken the immune system, including HIV/AIDS, cancer, organ transplantation, autoimmune diseases, and immunosuppressive medications, as stated in the most recent guideline 1. The conditions that make a patient immunocompromised can be categorized into several groups, including:
- Immunologic disorders, such as HIV infection or congenital immune deficiency syndrome
- Chronic diseases, such as diabetes, cancer, emphysema, or cardiac failure
- Immunosuppressive therapy, including radiation, cytotoxic chemotherapy, anti-rejection medication, or steroids, as defined in 1 and 1
- Autoimmune diseases, such as rheumatoid arthritis, lupus, and multiple sclerosis, which often require immunosuppressive treatments
- Medications that cause immunosuppression, including corticosteroids, chemotherapy agents, biologics, calcineurin inhibitors, and antimetabolites
- Other causes, such as congenital immunodeficiency disorders, splenectomy, malnutrition, diabetes, chronic kidney disease, and advanced age The degree of immunosuppression varies based on the underlying condition, medication dosage, and treatment duration, with some patients requiring antimicrobial prophylaxis, modified vaccination schedules, and special infection prevention measures, as recommended in 1. It is essential to note that the definition of an immunocompromised state is not clear-cut, and different categories of immunosuppression are recognized, depending on the severity of immunosuppression, as stated in 1. In clinical practice, it is crucial to identify patients who are immunocompromised and take appropriate measures to prevent infections and manage opportunistic infections, as these patients are at higher risk for infections and may have diminished vaccine responses, as mentioned in 1 and 1.
From the FDA Drug Label
For the treatment of documented Pneumocystis jirovecii pneumonia and for prophylaxis against P jirovecii pneumonia in individuals who are immunosuppressed and considered to be at an increased risk of developing P. jirovecii pneumonia. The condition that makes a patient immunosuppressed is not explicitly stated in the label, but it is implied that individuals at an increased risk of developing P. jirovecii pneumonia are those who are immunosuppressed.
- The label does not provide a specific list of conditions that make a patient immunosuppressed. 2
From the Research
Conditions that Make a Patient Immunocompromised
- Asplenia, which is the absence of a spleen, can make a patient immunocompromised, as the spleen plays a crucial role in filtering the blood and removing pathogens 3
- HIV infection is another condition that can make a patient immunocompromised, as it attacks and weakens the immune system 3, 4
- Solid organ transplant recipients are also immunocompromised, as they require immunosuppressive therapy to prevent rejection of the transplanted organ 3, 5
- Biologic use, such as the use of immunosuppressive medications, can also make a patient immunocompromised 3
- Cancer, particularly those with lymphopaenia, can also make a patient immunocompromised, as cancer and its treatment can weaken the immune system 3, 5
- Auto-immune diseases, such as those requiring corticosteroid therapy, can also increase the risk of immunocompromised state 5
Infectious Risks and Considerations
- Immunocompromised patients are at a higher risk of developing opportunistic infections, such as Pneumocystis jirovecii pneumonia (PCP) 6, 5, 7, 4
- PCP is a life-threatening infection that can be treated with trimethoprim-sulfamethoxazole, but this treatment can also have adverse effects, particularly in immunocompromised patients 6, 5, 7
- Prophylaxis against PCP is recommended for immunocompromised patients with risk factors, but the guidelines may need to be revised to reflect the current evidence 5