Persistent Attenuation of Lymphocyte Subsets After Mass SARS-CoV-2 Infection
Zhengqi Jiang, Tichao Shan, Yucan Li, Fengjiao Han, Baobao Feng, Xiaohui Zhen, Heyu Ni, Jun Peng, Miao Xu
sciencedirect.com·2025
Objectives
Growing evidence suggests that lymphocyte subsets are declined in COVID-19 patients, but it is unclear if these alterations persist after widespread exposure to SARS-CoV-2 or how long they last.
Methods
We analyzed lymphocyte subset data from 40,537 patients across three phases: pre-COVID, mass infection, and post-COVID. The counts of lymphocyte subsets and CD4+/CD8+ ratios were compared using Mann-Whitney U test or Kruskal-Wallis H test. Monthly post-exposure data were compared with pre-exposure data to assess the persistence of impact on lymphocyte subsets by SARS-CoV-2, and subgroup analyses were performed in patients with cardiovascular disease.
Results
During mass infection, T cells, CD4+T cells, CD8+T cells, NK cells, and B cells dropped significantly. Even 20 months post-infection, CD8+ T cells remained 9.9% below baseline. Baseline lymphocyte subsets differed significantly by sex and age. Immune recovery varied by age and sex, with older adults and males showing prolonged lymphopenia. In cardiovascular disease patients, T lymphocytes remained 72.9% below baseline for 20 months post-infection.
Conclusions
Our findings redefine SARS-CoV-2 infection as a condition of long-lasting immune compromise. The sustained subnormal lymphocytes—particularly in cardiovascular disease cohorts—highlight a key immunologic feature of long COVID and underscore the need for personalized care.