Bebell Lisa M, Ngonzi Joseph, Siedner Mark J, Muyindike Winnie R, Bwana Bosco M, Riley Laura E, Boum Yap, Bangsberg David R, Bassett Ingrid V
a Division of Infectious Diseases , Massachusetts General Hospital , Boston , MA , USA.
b Massachusetts General Hospital Center for Global Health , Boston , MA , USA.
AIDS Care. 2018 Aug;30(8):943-953. doi: 10.1080/09540121.2018.1434119. Epub 2018 Feb 16.
HIV infection may increase risk of postpartum infection and infection-related mortality. We hypothesized that postpartum infection incidence and attributable mortality in Mbarara, Uganda would be higher in HIV-infected than HIV-uninfected women. We performed a prospective cohort study of 4231 women presenting to a regional referral hospital in 2015 for delivery or postpartum care. All febrile or hypothermic women, and a subset of randomly selected normothermic women were followed during hospitalization and with 6-week postpartum phone interviews. The primary outcome was in-hospital postpartum infection. Secondary outcomes included in-hospital complications (mortality, re-operation, intensive care unit transfer, need for imaging or blood transfusion) and 6-week mortality. We performed multivariable regression analyses to estimate adjusted differences in each outcome by HIV serostatus. Mean age was 25.2 years and 481 participants (11%) were HIV-infected. Median CD4+ count was 487 (IQR 325, 696) cells/mm, and 90% of HIV-infected women (193/215 selected for in-depth survey) were on antiretroviral therapy. Overall, 5% (205/4231) of women developed fever or hypothermia. Cumulative in-hospital postpartum infection incidence was 2.0% and did not differ by HIV status (aOR 1.4, 95% CI 0.6-3.3, P = 0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P = 0.001). In-hospital mortality was rare (2/1768, 0.1%), and remained so at 6 weeks (4/1526, 0.3%), without differences by HIV serostatus (P = 1.0 and 0.31, respectively). For women in rural Uganda with high rates of antiretroviral therapy coverage, HIV infection did not predict postpartum infection or mortality, but was associated with increased risk of postpartum complications.
感染艾滋病毒可能会增加产后感染及感染相关死亡率的风险。我们推测，在乌干达姆巴拉拉，感染艾滋病毒的女性产后感染发病率及归因死亡率会高于未感染艾滋病毒的女性。我们对2015年到一家地区转诊医院进行分娩或产后护理的4231名女性开展了一项前瞻性队列研究。所有发热或体温过低的女性，以及一部分随机挑选的体温正常的女性在住院期间及产后6周通过电话访谈进行随访。主要结局是院内产后感染。次要结局包括院内并发症（死亡率、再次手术、转入重症监护病房、需要影像学检查或输血）及6周死亡率。我们进行了多变量回归分析，以估计按艾滋病毒血清学状态划分的各结局的校正差异。平均年龄为25.2岁，481名参与者（11%）感染了艾滋病毒。CD4 +细胞计数中位数为487（四分位间距325, 696）个/mm³，90%感染艾滋病毒的女性（193/215入选深度调查）接受了抗逆转录病毒治疗。总体而言，5%（205/4231）的女性出现发热或体温过低。院内产后感染累积发病率为2.0%，且在艾滋病毒状态方面无差异（调整后比值比1.4，95%置信区间0.6 - 3.3，P = 0.49）。然而，更多感染艾滋病毒的女性出现了产后并发症（4.4%对1.2%，P = 0.001）。院内死亡率很低（2/1768，0.1%），6周时依然如此（4/1526，0.3%），在艾滋病毒血清学状态方面无差异（P分别为1.0和0.31）。对于抗逆转录病毒治疗覆盖率高的乌干达农村女性，艾滋病毒感染不能预测产后感染或死亡率，但与产后并发症风险增加有关。
