How Common Variable Immunodeficiency Is Treated

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Common variable immunodeficiency (CVID) is an immune system disorder that occurs when a person does not have enough antibodies and becomes susceptible to frequent and potentially severe infections. At this time, CVID cannot be cured. Treatment for CVID primarily focuses on preventing and managing infections and monitoring for and treating other complications of CVID.

This article discusses the treatment options for CVID, including restoring antibodies through immunoglobulin (antibody) infusions or injections, and treating current infections through antibiotics or other methods.

Woman receives IV infusion with assistance from nurse in blue scrubs.

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Immunoglobulin Substitution

Immunoglobulin substitution is the mainstay treatment of CVID. It specifically targets the primary characteristic of CVID, which is reduced immunoglobulins.

Immunoglobulins, another word for antibodies, are proteins produced by the immune system that help defend our bodies against infections.

In CVID, a person does not have adequate numbers of antibodies (IgG and either IgA or IgM) to fight off infections. People with CVID become frequently sick, which can lead to complications. Therefore, treatment for this condition focuses on increasing the number of antibodies to better arm the immune system to defend itself.

Immunoglobulin substitution, also called immunoglobulin replacement therapy, restores the number of antibodies in a person's system. This is done by using donated blood from people who have healthy numbers of antibodies. Over 90% of people diagnosed with CVID are on this treatment. It will remain a lifelong treatment in order to prevent potentially dangerous infections.

Delivery

Immunoglobulin replacement therapy can be given in two ways:

  • Infusion (IVIG): Administered intravenously (through the veins), with a standard dosage of 400 to 600 milligrams per kilogram, every three to four weeks.
  • Injection (ScIG): Administered subcutaneously (shallow injection into the first layer of fat), with a standard dosage of 100 to 150 milligrams per kilogram per week. This is becoming the more common form of delivery.

Dosage and Frequency

Exact protocols for immunoglobulin replacement therapy can differ from person to person, depending on their unique antibody levels and any co-occurring infections.

For patients on subcutaneous immunoglobulin, the injections may be more frequent than those using intravenous immunoglobulin replacement, but can usually be performed at home.

Healthcare providers will determine the dosage and frequency at which a person receives their infusions or injections.

Some people with CVID can develop granulomatous inflammation in their body that can cause other manifestations including gastrointestinal problems and breathing problems. These may need additional medical treatments.

Inflammation in CVID

Because the immune system is also responsible for regulating inflammation, some patients with CVID will develop granulomatous inflammation and other complications that can cause symptoms in the lungs and gastrointestinal tract even when no infection is present.

Response

Studies show that people on immunoglobulin replacement therapy for CVID see self-reported improvements in quality of life, as well as reduced frequency and severity of infections.

Research also supports the importance of individualized treatment plans. People with CVID report better quality of life if they are able to receive infusions at home.

Cost of Treatment

Immunoglobulin replacement therapy can be an expensive treatment, which can lead to shortages or inequity of treatment availability around the world. However, properly treating CVID can lead to fewer hospitalizations, need for medication, and other costly treatments to manage recurrent infections.

One estimate found that in the United States, the cost of managing undiagnosed CVID is five times higher than the cost of actually treating CVID through immunoglobulin replacement therapy.

Over-the-Counter (OTC) Therapies

There is no over-the-counter (OTC) treatment that targets CVID itself. Immunoglobulin substitution is the only known treatment at this time.

However, if you have an active infection as a result of your CVID, there may be non-prescription medications you can use to manage your symptoms at home.

You should discuss any OTC medications with your healthcare provider if you have CVID. Some may be contraindicated based on other medications you are taking, or co-occurring conditions that you might have.

Prescriptions

Certain prescription medications may be used to treat the recurrent infections experienced by people with CVID. Antibiotics may be given for bacterial infections. Each infection will require tailored treatment with medications targeted to the infection's cause.

Research indicates that people with CVID tend to delay or avoid medical treatment for infections, which can lead to structural lung damage, such as in cases of complications like bronchiectasis or granulomas.

If you have CVID and develop an upper respiratory tract infection, or other infection, see your healthcare provider to discuss prescription medications.

Summary

Common variable immunodeficiency is an immune system disorder caused by low antibodies, reducing the body’s ability to fight off infections. The main treatment option is immunoglobulin (antibody) replacement therapy, as well as treatment for any resulting infections or complications due to CVID.

A Word From Verywell

Living with CVID can be complex and challenging, but for many, the treatments are straightforward. The majority of people with CVID are on immunoglobulin replacement therapy, either by infusions or injections. You will be on this treatment for life, so it will require emotional acceptance of the condition and schedule management.

Managing ongoing infections is a secondary, but still very important aspect of CVID treatment. This treatment will depend on your case and the type of infection. For some patients, CVID complications may require medications in addition to antibiotics to treat infections and regular immunoglobulin infusions. Overall, most people with properly-treated CVID have a strong quality of life.

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8 Sources
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