Ganesh Prakash R, Mernoff Rachel, Dikkers Renske, Nundwe William, Pope Rachel
Department of Family Medicine and Community Health, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, USA.
Lighthouse Trust, Lilongwe, Malawi.
Int J MCH AIDS. 2021;10(2):191-197. doi: 10.21106/ijma.509. Epub 2021 Oct 30.
Obstetric fistula affects approximately 2 million women worldwide, predominantly in places with a high Human Immunodeficiency Virus (HIV) burden. In Malawi, where thousands of women live with fistulas, HIV prevalence is 11-13%. Although repair is usually successful, surgical outcomes among immunocompromised women are poorly understood. Inconsistent guidelines regarding the Cluster of Differentiation 4 (CD4) threshold necessary for repair make it difficult for surgeons to make informed decisions. This study compares the postoperative outcomes of women undergoing obstetric fistula repair with and without HIV, stratified by CD4 count.
This is a retrospective case-control study using a database of women who underwent vesicovaginal fistula repair at the Fistula Care Center from 2010-2018. HIV-positive participants, stratified by CD4<350 and CD4>350, were matched to HIV-negative controls by age within 5 years and Goh classification. Controls were matched to cases in a 3:1 ratio. Bivariate analysis and logistic regression were conducted on indicators based on HIV status and CD4 count stratification. Outcomes included dye test results, pad weights, and continence status at 2 weeks post-repair.
54 seropositive women were matched to 135 seronegative women. Of the 54 HIV positive women, 22.2% (n=12) had a CD4 count < 350. We found no statistically significant difference in surgical outcomes between HIV-positive and negative patients. 93.5% of HIV positive and 90% of HIV negative women healed completely. In our sub-analysis of 12 seropositive women with CD4<350, we found a statically significant difference in successful closure, with 25% of women with CD4<350 having a positive dye test indicating incomplete closure, compared to 2.8% of women with CD4>350 (p=0.024).
Our analysis confirms previous research indicating that seropositive women with a CD4>350 can safely undergo obstetric fistula repair. Further research is needed to evaluate postoperative outcomes among women with CD4<350.
产科瘘影响着全球约200万女性，主要集中在人类免疫缺陷病毒（HIV）负担较重的地区。在马拉维，有成千上万患有瘘管病的女性，HIV感染率为11%-13%。尽管修复手术通常很成功，但免疫功能低下女性的手术效果却知之甚少。关于修复所需的分化簇4（CD4）阈值的指导方针不一致，这使得外科医生难以做出明智的决策。本研究比较了按CD4计数分层的有HIV和无HIV的产科瘘修复女性的术后结果。
这是一项回顾性病例对照研究，使用了2010年至2018年在瘘管病护理中心接受膀胱阴道瘘修复手术的女性数据库。HIV阳性参与者按CD4<350和CD4>350分层，与年龄在5岁以内且戈氏分类相同的HIV阴性对照进行匹配。对照组与病例的匹配比例为3:1。基于HIV状态和CD4计数分层对指标进行双变量分析和逻辑回归。结果包括修复后2周的染料试验结果、护垫重量和控尿状态。
54名血清阳性女性与135名血清阴性女性相匹配。在54名HIV阳性女性中，22.2%（n=12）的CD4计数<350。我们发现HIV阳性和阴性患者的手术结果在统计学上没有显著差异。93.5%的HIV阳性女性和90%的HIV阴性女性完全愈合。在我们对12名CD4<350的血清阳性女性的亚分析中，我们发现成功闭合存在统计学显著差异，CD4<350的女性中有25%的染料试验呈阳性，表明闭合不完全，而CD4>350的女性中这一比例为2.8%（p=0.024）。
我们的分析证实了先前的研究，即CD4>350的血清阳性女性可以安全地接受产科瘘修复手术。需要进一步研究来评估CD4<350的女性的术后结果。
