Intensive Management of a Patient with HIV, Active Tuberculosis, and COVID-19: A Multidisciplinary Approach in the Intensive Care Unit

Coinfection with HIV, active tuberculosis, and COVID-19 is rare but markedly increases mortality risk and complicates treatment due to the interactions between these infections. Management requires a multidisciplinary approach that integrates antiretroviral therapy, antituberculous drugs, antibiotics, and supportive care for COVID-19. We report the case of a 28-year-old male with HIV (viral load 30 copies, CD4 count 303), active tuberculosis, and a history of resolved syphilis, who presented with severe respiratory decompensation and hypoxemia (SpO₂ 55%), requiring orotracheal intubation. Initial treatment included broad-spectrum antibiotics, antiretrovirals, and antituberculous therapy. Despite the critical illness, the patient demonstrated progressive clinical improvement, was successfully extubated after a spontaneous breathing trial, and continued recovery under supplemental oxygen. This case underscores the clinical complexity of triple coinfection and highlights the potential for favorable outcomes when management is timely and multidisciplinary.