ORCHESTRA Delphi consensus: diagnostic and therapeutic management of Post-COVID-19 condition in vulnerable populations, 2025, Gentilotti et al

ORCHESTRA Delphi consensus: diagnostic and therapeutic management of Post-COVID-19 condition in vulnerable populations

Elisa Gentilotti, Lorenzo Maria Canziani, Maria Giulia Caponcello, Anna Maria Azzini, Alessia Savoldi, Pasquale De Nardo, Zaira R. Palacios-Baena, Beatrice Tazza, Natascia Caroccia, Giulia Marchetti, Andrea Antinori, Maddalena Giannella, Jesús Rodríguez-Baño, Evelina Tacconelli, On behalf of Expert team, Expert team ORCHESTRA SOT panel ∙ Expert team ORCHESTRA PWH panel ∙ Expert team ORCHESTRA RD panel ∙ Expert team ORCHESTRA HM panel ∙ ORCHESTRA WP4 working group

Abstract

Background

Post-COVID condition (PCC) remains poorly understood, especially in clinically vulnerable groups. Within the ORCHESTRA Project, we applied the Delphi approach to drive recommendations for the diagnosis, management, and prevention of PCC in people living with HIV (PWH) and patients affected by rheumatological diseases (RD) and haematological malignancies (HM).

Methods

Based on literature review, three areas of interest in PCC in PWH, HM, and RD were identified: 1) features and risk factors; 2) diagnosis and management; and 3) prevention. A three-round Delphi anonymous survey consisting of 15 questions was conducted including 69 experts. Consensus was measured by the 6-point Likert scale categorised into four tiers: strong disagreement, moderate disagreement, moderate agreement, and strong agreement. Statements were generated on questions achieving consensus.

Results

Eleven statements were generated: six on features and risk factors of PCC in clinically vulnerable populations, two on diagnosis and management, and three on prevention. Chronic fatigue was identified as the most frequent presentation of PCC in PWH and RD populations. A different case definition of PCC is required for RD population, as symptoms of PCC and autoimmune disorders may overlap. Risk factors for PCC include age>65, severity of COVID-19, and female sex; this latter is also associated with increased smell/taste impairment. A clinical assessment or a routine laboratory test performed three months after acute infection is not suggested to diagnose PCC in PWH. PWH and RD should be screened to exclude additional autoimmune disorders in case of chronic fatigue/arthralgia of new onset. Full-course vaccination and early treatment for COVID-19 should be promoted to prevent PCC, while corticosteroids during acute infection are not recommended.

Conclusion

Diagnosis, management and prevention of PCC are still under discussion. This Delphi offers valuable insights on PCC in selected clinically vulnerable populations and suggests a tailored approach in vulnerable populations.

link (Clinical Microbiology and Infection) [journal pre-proof]
https://doi.org/10.1016/j.cmi.2025.04.009