Immune deficiency common variable

Overview

Common variable immunodeficiency (CVID) is a condition where the immune system does not make enough antibodies — special proteins that help your body fight off infections. This means you may get infections more often, especially in the ears, sinuses, and lungs. It is called 'variable' because the symptoms and severity can be very different from person to person.

CVID is rare. It is thought to affect about 1 in 25,000 to 50,000 people worldwide.

CVID can affect anyone, but it is most often diagnosed in adults between 20 and 40 years old. It occurs in men and women about equally, and some people have family members with immune system problems.

Symptoms

Common symptoms

• Repeated infections, such as pneumonia, bronchitis, sinus infections, or ear infections
• Infections that keep coming back or do not clear with standard antibiotics
• Digestive problems, including diarrhea, bloating, or weight loss
• Swollen lymph nodes (small glands in the neck, armpits, or groin)
• Autoimmune problems, such as low blood counts, joint pain, or inflammation
• Ongoing fatigue or feeling unwell

Symptoms in children

• Frequent respiratory infections that are unusual or severe
• Slow growth or trouble gaining weight
• Digestive symptoms like diarrhea or poor appetite
• Delays in reaching developmental milestones due to illness

Symptoms in older adults

• More severe or frequent infections that may lead to lung damage
• Ongoing fatigue that affects daily life
• Increased risk of chronic lung conditions or organ complications
• Autoimmune conditions like anemia or low platelets may appear more often

Causes

Main causes

• The exact cause of CVID is not fully understood.
• Some people have changes in genes that help the immune system work, but these are not found in every case.
• It is usually not inherited in a clear pattern, although about 10% of cases run in families.
• A trigger, such as a viral infection, may play a role in starting the immune imbalance.

Risk factors

• Having a family member with CVID or another primary immunodeficiency
• Having other autoimmune disorders
• Being between 20 and 40 years old at the time symptoms start, though anyone can be affected

When to see a doctor

See a doctor urgently if:

• Infections that keep returning or that need multiple courses of antibiotics
• Any infection that seems more severe than usual or is not clearing after a few days
• Persistent lung symptoms like a cough or wheezing over several weeks

Book a routine appointment if:

• If you have had several ear, sinus, or chest infections in one year
• If you are losing weight without trying or have ongoing diarrhea
• If you feel extremely tired all the time and cannot find a reason

Diagnosis

Diagnosing CVID usually starts with a detailed conversation about your infection history and physical exam. Your doctor will then order blood tests to check your immunoglobulin levels and see how well your immune system responds to vaccines. Because there is no single perfect test, other conditions must be ruled out first.

Tests that may be done

• Blood tests: immunoglobulin levels (IgG, IgA, IgM), complete blood count, and vaccine response tests
• Urine tests to check for protein loss
• Lung function tests and CT scans if you have frequent respiratory infections
• Gastrointestinal tests, like endoscopy, if you have digestive symptoms
• Genetic testing may be offered in some cases

What to expect at your appointment

You will likely be referred to a clinical immunologist — a doctor who specializes in immune system disorders. Diagnosis can take time, sometimes months or years, because your doctor needs to see a pattern of infections and test results. It is normal to feel frustrated during this process, but a careful diagnosis is the first step to the right treatment.

Treatment

While there is no cure for CVID, treatment is very effective. The main approach is to replace the missing antibodies with regular immunoglobulin therapy. This is given either through a vein (IV) or under the skin (subcutaneous infusion). With consistent treatment, most people have far fewer infections and can maintain a good quality of life.

Self-care at home

• Practice good handwashing and avoid touching your face.
• Keep up to date with safe vaccines (avoid live vaccines unless your immunologist says they are safe).
• Stay alert for early signs of infection, like a scratchy throat or sinus pressure, and contact your care team early.
• Carry a medical alert card or bracelet so emergency providers know about your immune condition.
• Get enough sleep, manage stress, and follow a balanced routine.

Medical treatments

Medical treatment for CVID usually includes regular immunoglobulin replacement therapy, which is the main way to help prevent infections. Your doctor may also prescribe antibiotics to treat or prevent specific infections, and sometimes additional medicines to manage autoimmune complications. Treatments are always tailored to your individual situation.

When is surgery considered?

Surgery is not usually needed for CVID itself. However, occasionally surgery may be recommended to drain a persistent infection, remove a piece of lung tissue for testing, or address chronic sinus problems. Your specialist will discuss the risks and benefits with you if surgery is ever suggested.

Living with this condition

Living with CVID means building a routine that protects your health. This includes keeping a regular schedule for your immunoglobulin infusions, staying alert to early symptoms of infection, and working closely with your healthcare team. With planning, you can do most normal activities, including work, travel, and social life.

Lifestyle tips

• Set up a comfortable and consistent routine for infusions at home or at a clinic.
• Avoid crowded places during flu season when possible.
• Let family, friends, and employers know about your condition if you feel safe doing so.
• Prepare a travel kit with necessary medications and a doctor's letter explaining your treatment.

Diet and exercise

A balanced diet with plenty of fruits, vegetables, whole grains, and protein helps support your body. Gentle exercise like walking, swimming, or yoga can improve your energy and mood. Always check with your doctor before starting a new demanding exercise routine.

Mental health and emotional wellbeing

Living with a chronic condition can sometimes feel worrying or isolating. It is completely normal to feel anxious, frustrated, or low at times. Talking to a therapist or counselor, joining a support group, and staying connected to friends and family can help. Your feelings matter, and your care team can connect you with mental health resources.

Prevention

CVID cannot be prevented because the underlying immune problem is present from birth or develops early in life. However, the infections caused by CVID can be greatly reduced with regular treatment and careful habits.

Vaccines

Vaccines are important, but not all vaccines are safe for people with CVID. Inactivated (killed) vaccines are usually safe, while live vaccines like measles, mumps, rubella, chickenpox, or the nasal flu vaccine may be risky. Always talk to your immunologist before receiving any vaccine.

Screening programmes

There is no routine screening for CVID in the general population. If you have a family history of primary immunodeficiency, you may want genetic counseling and immune testing. Early diagnosis and treatment lead to better long-term health.

Complications

If left untreated

• Damage to the lungs from repeated infections, such as bronchiectasis (scarring of the airways)
• Chronic sinus and ear disease that can affect hearing
• Severe infections like pneumonia or meningitis
• Digestive issues due to chronic inflammation
• Higher risk of certain cancers, especially lymphoma
• Autoimmune conditions that can affect blood cells, joints, or organs

Long-term outlook

With early diagnosis and regular immunoglobulin replacement therapy, most people with CVID live full and active lives. The goal is to prevent infections and manage complications before they become serious. It is a lifelong condition, but modern treatment has made a remarkable difference. Your healthcare team will partner with you in making this manageable.

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