A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV
Background and Objective: 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, surgica...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Global Health and Education Projects, Inc.
2021-10-01
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| Series: | International Journal of Maternal and Child Health and AIDS |
| Subjects: | |
| Online Access: | https://mchandaids.org/index.php/IJMA/article/view/509 |
| _version_ | 1828139912223784960 |
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| author | Prakash Ganesh Rachel Mernoff Renske Dikkers William Nundwe Rachel Pope |
| author_facet | Prakash Ganesh Rachel Mernoff Renske Dikkers William Nundwe Rachel Pope |
| author_sort | Prakash Ganesh |
| collection | DOAJ |
| description | Background and Objective: 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.
Methods: 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.
Results: 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).
Conclusion and Global Health Implications: 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.
Copyright © 2021 Ganesh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0. |
| first_indexed | 2024-04-11T19:00:06Z |
| format | Article |
| id | doaj.art-caababe8bc264cf19844199b3071a8ef |
| institution | Directory Open Access Journal |
| issn | 2161-8674 2161-864X |
| language | English |
| last_indexed | 2024-04-11T19:00:06Z |
| publishDate | 2021-10-01 |
| publisher | Global Health and Education Projects, Inc. |
| record_format | Article |
| series | International Journal of Maternal and Child Health and AIDS |
| spelling | doaj.art-caababe8bc264cf19844199b3071a8ef2022-12-22T04:08:05ZengGlobal Health and Education Projects, Inc.International Journal of Maternal and Child Health and AIDS2161-86742161-864X2021-10-01102A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIVPrakash Ganesh0Rachel Mernoff1Renske Dikkers2William Nundwe3Rachel Pope4Department of Family Medicine and Community Health, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, USA; Lighthouse Trust, Lilongwe, MalawiUC Berkeley-UCSF Joint Medical Program, 533 Parnassus Ave, San Francisco CA 94143, USAAmphia Hospital, Molengracht 21, 4818 CK Breda, The NetherlandsBaylor Foundation, Lilongwe, MalawiUrology Institute, Division of Female Sexual Health, University Hospitals Cleveland Medical Center, USABackground and Objective: 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. Methods: 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. Results: 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). Conclusion and Global Health Implications: 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. Copyright © 2021 Ganesh et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.https://mchandaids.org/index.php/IJMA/article/view/509Obstetric FistulaSurgical OutcomesHIVVesicovaginal FistulaFistula RepairCD4 |
| spellingShingle | Prakash Ganesh Rachel Mernoff Renske Dikkers William Nundwe Rachel Pope A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV International Journal of Maternal and Child Health and AIDS Obstetric Fistula Surgical Outcomes HIV Vesicovaginal Fistula Fistula Repair CD4 |
| title | A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV |
| title_full | A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV |
| title_fullStr | A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV |
| title_full_unstemmed | A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV |
| title_short | A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV |
| title_sort | comparison of postoperative surgical outcomes among women undergoing obstetric fistula repair with and without hiv |
| topic | Obstetric Fistula Surgical Outcomes HIV Vesicovaginal Fistula Fistula Repair CD4 |
| url | https://mchandaids.org/index.php/IJMA/article/view/509 |
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