Low complication rate associated with cesarean section under spinal anesthesia for HIV-1-infected women on antiretroviral therapy.
BACKGROUND
Elective cesarean section decreases the likelihood of vertical human immunodeficiency virus (HIV) transmission from mother to infant. This study aimed to determine whether cesarean section done with spinal anesthesia on HIV-1-infected pregnant women taking antiretroviral therapy is associated with intraoperative hemodynamic instability, postoperative complications, or changes in immune function or HIV-1 viral load.


METHODS
A case-controlled study was conducted over a 3-year period in a London academic hospital. Forty-four women infected with HIV-1 and a control group of 45 HIV-negative women undergoing cesarean sections were included. The main outcome measures included intraoperative blood pressure, heart rate, blood loss, and ephedrine requirements, and postoperative infective complications, blood transfusion, changes in blood HIV-1 viral load and lymphocyte subsets, and time to hospital discharge.


RESULTS
There were no differences in hemodynamic stability and postoperative complications between the HIV-infected group and the controls. There was an acute postoperative increase in the CD4T lymphocyte count (P = 0.01), but the CD4T:CD8T ratio and viral load did not change.


CONCLUSIONS
Elective cesarean section under spinal anesthesia for women infected with HIV-1 taking antiretroviral therapy was not associated with intraoperative or postoperative complications.
Avidan
Michael S
MS
Departments of Anaesthetics, Obstetrics, Sexual Health, Virology, Immunology, and Child Health, King's College Hospital NHS Trust, London, SE5 9RS, United Kingdom.
Groves
Philippa
P
Blott
Margaret
M
Welch
Jan
J
Leung
Theresa
T
Pozniak
Anton
A
Davies
Edward
E
Ball
Colin
C
Zuckerman
Mark
M
D000293:Adolescent; D000328:Adult; D000775:Anesthesia, Spinal; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016022:Case-Control Studies; D002585:Cesarean Section; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006439:Hemodynamics; D006801:Humans; D011183:Postoperative Complications; D011247:Pregnancy
D019380:Anti-HIV Agents