Increased peri- and post-elective cesarean section morbidity in women infected with human immunodeficiency virus-1: a case-controlled multicenter study.
OBJECTIVE
Although elective cesarean section (ECS) is the currently recommended modality for delivering women infected with the human immunodeficiency virus (HIV), historical evidence suggests that they are at higher risk of postoperative complications than noninfected women. Those risks have to be carefully balanced against the presumed minimal benefit of ECS, especially in the case of low viral load and high CD4 counts. We therefore compared the incidence and type of post-ECS complications in HIV-infected women, most with low viral loads and high CD4 cell counts, with those in matched noninfected women treated by the same surgical teams.


METHODS
A Swiss 8-center, prospective, matched case-control study compared minor and major post-ECS complication prevalence, hospital stay and confounding factors (surgeon experience) between HIV-infected and noninfected women.


RESULTS
Minor complications in the 53 matched pairs were eightfold more frequent overall in infected women. More frequent specific minor complications were anemia, blood loss and urinary tract infection. Yet the surgeons performing ECS in infected women were more experienced. Complications prolonged hospital stay in infected women. Major complication rates did not significantly differ between the groups.


CONCLUSIONS
HIV-positive women have a higher risk of post-ECS morbidity, even with high CD4 counts and low viral load. Therefore, the blanket recommendation of ECS in HIV-infected women requires a review.
Lapaire
Olav
O
University Women's Hospital, Basel, Switzerland.
Irion
Olivier
O
Koch-Holch
Annemarie
A
Holzgreve
Wolfgang
W
Rudin
Christoph
C
Hoesli
Irène
I
D000328:Adult; D015704:CD4 Antigens / Q000097:blood; D016022:Case-Control Studies; D002585:Cesarean Section / Q000009:adverse effects*; D017558:Elective Surgical Procedures / Q000009:adverse effects*; D005260:Female; D015658:HIV Infections / Q000150:complications* / Q000635:transmission; D015497:HIV-1; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D011183:Postoperative Complications / Q000453:epidemiology*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D015819:Substance Abuse, Intravenous / Q000150:complications; D019562:Viral Load
D015704:CD4 Antigens