Severely immunocompromised for access to COVID-19 antiviral treatments

Clinicians can use this list to identify if people meet the criteria for "severely immunocompromised" under the COVID-19 antivirals access criteria.

Severly immunocompromised as relates to antiviral access criteria 4.4 for nirmatrelvir with ritonavir and remdesivir.

  • heart or lung transplant recipient (any time frame)
  • other solid-organ transplant recipient with any of the following:
    • transplant received within the last 12 months
    • receiving induction immunosuppressant treatment (any timeframe)
    • receiving maintenance immunosuppressant treatment that includes mycophenolate mofetil (any timeframe)
    • treated for graft rejection within the past 12 months
  • allogenic haematopoietic stem cell transplant recipient with any of the following:
    • transplant received within last 12 months
    • has chronic graft versus host disease
    • requires significant ongoing immunosuppression for another reason
  • autologous haematopoietic stem cell transplant received within the last 12 months
  • multiple myeloma on active and/or maintenance treatment
  • combined primary immunodeficiency syndromes (including Severe Combined Immunodeficiency (SCID))
  • common variable immunodeficiency (CVID) with additional T-cell defects, past opportunistic infection or requiring immunosuppressive therapy
  • diagnosed humoral immunodeficiency with baseline IgG < 3g/L
  • HIV with a CD4 T lymphocyte cell count <200 cells/mm3
  • person who is receiving:
    • potent B-cell or T-cell depleting therapy within the previous 12 months*
    • a B-cell inhibitor (e.g. venetoclax or a Bruton tyrosine kinase inhibitor)
    • ruxolitinib
    • regular 3-4-weekly intravenous or subcutaneous immunoglobulin
    • sphingosine 1- phosphate receptor modulator therapy (eg fingolimod) within previous 12 months
    • high dose cyclophosphamide (>1g/m2) within previous 6 months.
    • high-dose or long-term moderate dose corticosteroids
  • is considered otherwise severely immunocompromised and had been given, or would have been given a third dose in their primary course of COVID-19 vaccine 


* potent B-cell or T-cell depleting therapy such as rituximab, obinutuzumab, ocrelizumab, bendamustine, fludarabine, cladribine, alemtuzumab, anti-thymocyte globulin, CamPath antibody treatment, anti-B-cell bispecific antibody, CAR T-cells or BiTE antibody treatment.