A rare case of autoimmune hemolytic anemia secondary to HCV/HIV coinfection complicated with chronic kidney disease

Abstract Background: Autoimmune hemolytic anemia (AIHA) is an acquired disorder characterized by destruction of RBCs auto-antibodies, leading to varying degrees of anemia, from mild to life-threatening. Human immunodeficiency virus (HIV) can trigger autoimmunity complications including Autoimmune hemolytic anemia through various molecular mechanisms. Moreover AIHA is considered a rare extrahepatic manifestation of hepatitis-C virus. HCV/HIV coinfection increases the risk of AIHA incidence Case report: A 42-year-old male patient with a history of IV drug abuse and chronic HCV/HIV coinfection referred to the emergency center with complaints of lethargy, fatigue and shortness of breath. The patient’s past medical history revealed that he was nondiabetic and non-hypertensive and nonalcoholic. In the physical examination, icteric sclera and mild splenomegaly were evident. Considering the severe anemia (Hgb: 3.9 mg/dl), hyperbilirubinemia (Total/direct bilirubin: 2.5/0.6 mg/dl), elevated LDH, splenomegaly, positive HCV and HIV serological tests and positive coombs test, diagnosis of AIHA secondary to HIV/HCV was entertained. Discussion: We presented a rare case of AIHA secondary to HCV/HIV co-infection with concurrent acute severe hepatitis and ESRD. The exact cause of increased CKD risk in HCV-HIV co-infected individuals remains unclear. Chronic HCV infection is associated with increased deterioration of renal function and incidence of ESRD and CKD. A wide range of kidney diseases might occur in HIV positive Patients and HCV/HIV coinfection is associated with aggravation of renal failure. CKD risk is higher in HCV co-infected patients compared to those with HIV mono-infection. Conclusion: AIHA is rare cause of anemia and a potentially life-threatening phenomena in HCV/HIV infected individuals. A high degree of clinical suspicion for AIHA diagnosis in patients with HCV/HIV coinfected is crucial for proper management. Moreover HCV/HIV coinfection is associated with progression to CKD.