Article Text

Download PDFPDF
Resolution of possible acquired protein S deficiency after viral suppression in HIV infection
  1. Leigh Cervino1,
  2. Jillian Raybould2 and
  3. Patricia Fulco3
  1. 1Pharmacy, Johns Hopkins Hospital, Baltimore, MD, USA
  2. 2Department of Internal Medicine/Division of Infectious Diseases, Virginia Commonwealth University, Richmond, Virginia, USA
  3. 3Department of Pharmacy, Virginia Commonwealth University Health System, Richmond, Virginia, USA
  1. Correspondence to Dr Patricia Fulco; patricia.fulco{at}


Current literature suggests an increased risk of venous thromboembolism (VTE) in people living with HIV (PLWH) with poorly controlled viraemia and immunodeficiency. VTE treatment guidelines do not specifically address anticoagulation management in PLWH. We report a case of a 33-year-old woman diagnosed with an unprovoked pulmonary embolism (PE) and deemed protein S deficient. Three years later, she was diagnosed with AIDS. Antiretroviral therapy (ART) was promptly initiated with viral suppression and immune reconstitution within 12 months. Eight years after her initial PE, the patient self-discontinued warfarin. Multiple repeat protein S values were normal. ART without anticoagulation has continued for 3 years with no thrombotic events. This case describes a patient with VTE presumably secondary to undiagnosed HIV with possible consequent acquired protein S deficiency. Additional research is needed to understand the characteristics of PLWH with VTE who may warrant long-term anticoagulation as opposed to shorter courses.

  • HIV / AIDS
  • venous thromboembolism
  • warfarin therapy
  • pulmonary embolism

Statistics from


  • Contributors LC conceptualised the manuscript, reviewed and analysed the patient data, designed the flow of the manuscript/tables with literature review and revised all drafts. PF is the corresponding author, conceptualised the manuscript, provided direct patient care with acquisition/interpretation of data, reviewed the medical literature, designed the manuscript/tables and revised all drafts. JR provided direct patient care with acquisition/interpretation of data, reviewed the medical literature and revised all drafts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.