Increased peri- and post-elective cesarean section morbidity in women infected with human immunodeficiency virus-1: a case-controlled multicenter study

Abstract

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. Study design: 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. Conclusion: 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.

Appendix

The Swiss HIV Cohort Study (SHCS) and the Swiss Mother and Child HIV Study (MoCHiV) members: Manuel Battegay, Enos Bernasconi, Kurt Biedermann, Jürg Böni, Heiner Bucher, Philippe Bürgisser, Sandro Cattacin, M. Cavassini, Rolf Dubs, Matthias Egger, Luigia Elzi, Peter Erb, Karin Fantelli, Marek Fischer, Markus Flepp, Adriano Fontana, Patrick Francioli (SHCS President), Hansjakob Furrer (SHCS Clinical and Laboratory Committee Chairman), Meri Gorgievski, Huldrych Günthard, Bernard Hirschel, Irène Hösli, Christian Kahlert, Laurent Kaiser, Urs Karrer, Olivia Keiser, Christian Kind, Thomas Klimkait, Bruno Ledergerber, Gladys Martinetti, Begona Martinez de Tejada, Nicolas Müller, David Nadal, Milos Opravil, Fred Paccaud, Giuseppe Pantaleo, Luc Perrin, Martin Rickenbach, Christoph Rudin (Chairman, MoChiV), Patrick Schmid, Detlev Schult${\text{\ifmmode\expandafter\ddot\else\expandafter\"\fi{z}}}$e, Jörg Schüpbach, Roberto Speck, Patrick Taffé, Philip Tarr, Amalio Telenti, Alexandra Trkola, Pietro Vernazza (SHCS Scientific Board Chairman), Rainer Weber, Sabine Yerly.