COVID-19 in the Setting of HIV and Severe Hemophilia A: A Case Report

A hyperactive immune response is the driving force behind severe Coronavirus disease 2019 (COVID-19). Complications of severe COVID-19 include acute respiratory distress syndrome, acute respiratory failure, and increased risk of venous thromboembolism (VTE). The management of patients with COVID-19 includes respiratory support, decreasing immune response to the virus to prevent the progression of disease, and anticoagulation to prevent VTE.

We present the case of a patient with a history of human immunodeficiency virus (HIV) and hemophilia A admitted with COVID-19. This case demonstrates the difficulties present when managing COVID-19 in patients with specific comorbidities. Anticoagulation is a recommended component of COVID-19 treatment but is contraindicated in patients with severe hemophilia due to increased risk for bleeding. Research has also shown that dexamethasone decreases mortality in patients with COVID-19, but doctors should use dexamethasone cautiously in patients with HIV since it is an immunosuppressant. Taking certain antiretroviral therapies, such as rilpivirine, also contraindicates the use of dexamethasone.

In this case, it is important to monitor for the risk and presence of superimposed bacterial or opportunistic infections. Treating a patient with these comorbidities who is infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) highlights the importance of balancing the risks and benefits.