Sotrovimab and Antivirals for Immunocompromised Skin Infections

Overview / DefinitionSotrovimab is a monoclonal antibody that targets the spike protein of the SARS-CoV-2 virus, providing therapeutic options for patients with COVID-19, particularly in those who are immunocompromised. In addition, antivirals such as acyclovir, valacyclovir, and famciclovir are essential in the treatment of various viral skin infections, including herpes simplex virus (HSV) and varicella-zoster virus (VZV) infections.EpidemiologyThe prevalence of skin infections in immunocompromised patients is significantly higher than in the general population. Among these patients, the risk of viral infections, including HSV and VZV, is particularly concerning. Factors contributing to this increased risk include:Use of immunosuppressive therapy (e.g., chemotherapy, corticosteroids)Underlying conditions (e.g., HIV/AIDS, organ transplantation)Age-related immune declinePathophysiology / MechanismThe immune system typically protects against viral infections through cellular immunity and humoral responses. In immunocompromised patients, these defenses are weakened, allowing for reactivation of latent viruses or increased susceptibility to new infections. Sotrovimab works by binding to the spike protein of SARS-CoV-2, preventing the virus from entering cells and replicating. Antivirals like acyclovir inhibit viral DNA synthesis, effectively decreasing the viral load.Clinical PresentationSkin infections in immunocompromised patients can present variably, but common clinical features include:Vesicular lesions in HSV infectionsShingles (herpes zoster) with dermatomal distributionUlcerations and crusting in severe casesSystemic signs in cases of disseminated infection (e.g., fever, malaise)Diagnosis / WorkupDiagnosis of viral skin infections in immunocompromised patients involves:Clinical evaluation of the skin lesionsPolymerase chain reaction (PCR) testing for HSV or VZVSerological tests to evaluate for prior exposure or active infectionSkin biopsy in atypical cases to r