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Ganesh PR, Mernoff R, Dikkers R, et al. A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV. Int J MCH AIDS. 2021;10(2):191-197doi: 10.21106/ijma.509.
Ganesh, P. R., Mernoff, R., Dikkers, R., Nundwe, W., & Pope, R. (2021). A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV. International journal of MCH and AIDS, 10(2), 191-197. https://doi.org/10.21106/ijma.509
Ganesh, Prakash R, et al. "A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV." International journal of MCH and AIDS vol. 10,2 (2021): 191-197. doi: https://doi.org/10.21106/ijma.509
Ganesh PR, Mernoff R, Dikkers R, Nundwe W, Pope R. A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV. Int J MCH AIDS. 2021;10(2):191-197. doi: 10.21106/ijma.509. Epub 2021 Oct 30. PMID: 34804637; PMCID: PMC8590090.
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Int J MCH AIDS. 2021;10(2):191-197. doi: 10.21106/ijma.509. Epub 2021 Oct 30.

A Comparison of Postoperative Surgical Outcomes among Women Undergoing Obstetric Fistula Repair with and without HIV.

International journal of MCH and AIDS

Prakash R Ganesh, Rachel Mernoff, Renske Dikkers, William Nundwe, Rachel Pope

Affiliations

  1. Department of Family Medicine and Community Health, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, USA.
  2. Lighthouse Trust, Lilongwe, Malawi.
  3. UC Berkeley-UCSF Joint Medical Program, 533 Parnassus Ave, San Francisco CA 94143, USA.
  4. Amphia Hospital, Molengracht 21, 4818 CK Breda, The Netherlands.
  5. Baylor Foundation, Lilongwe, Malawi.
  6. Urology Institute, Division of Female Sexual Health, University Hospitals Cleveland Medical Center, USA.

PMID: 34804637 PMCID: PMC8590090 DOI: 10.21106/ijma.509

Abstract

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.

Keywords: AIDS; CD4; Fistula Repair; HIV; Malawi; Obstetric Fistula; Sub-Saharan Africa; Surgical Outcomes; Vesicovaginal Fistula

Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to disclose.

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