Ribavirin Treatment for Respiratory Syncytial Virus in Immunocompromised Hosts

Intro: Respiratory syncytial virus (RSV) is a common virus that can cause infection in the immunocompromised population.. In patients with hematologic malignancies, mortality rates have ranged from 7% to 83%. Most studies have focused on allogeneic stem cell transplant patients; however, those that have studied hematologic malignancies have shown equivalent RSV related mortality rates. Mortality is seen in the setting of lower respiratory tract infections (LRTI) and RSV progresses to lower respiratory tract infection in 40-50% of infected patients. In this study, we reviewed the charts of 35 immunocompromised, hospitalized patients diagnosed with RSV and treated with oral Ribavirin +/- IVIG to evaluate clinical outcome.

Methods: A retrospective chart review was conducted on 35 patients who tested positive for RSV via polymerase chain reaction (PCR). Data was collected between January 2010 and July 2016. These patients were treated with oral Ribavirin 10mg/kg loading dose on day 1, 400mg q8h on day 2 followed by 600mg q8h for the duration of the therapy from day 3 forward with or without IVIG 500mg/kg weekly as per treating physician.

Results: The cohort consisted of 20 males and 15 females. There were13 allogeneic stem cell transplant patients, 1 autologous stem cell transplant patient, and 21 patients with hematologic malignancies actively undergoing chemotherapy. Thirty-three patients were tested via nasopharyngeal swab and two were tested via BAL. Twenty were diagnosed with LRTI and 15 diagnosed with upper respiratory tract infection (URTI). Twenty one patients developed worsening hypoxemia with increased oxygen requirement. Two patients were intubated. Thirty patients were treated with Ribavirin and IVIG and 5 patients with Ribavirin alone. Sixteen patients started treatment within 2-3 days of positive RSV PCR and the rest began treatment after 3 days. All patients showed clinical improvement within 14 days of treatment. No patients died during the treatment period.

Conclusion: In our cohort,oral ribavirin with or without IVIG was an effective treatment for RSV infection in immunocompromised patients with hematologic malignancies. Further studies are needed to confirm this result.