HIV Infection and Risk of Postpartum Infection, Complications and Mortality in Rural Uganda
National Institutes of Health Research Training [grant number R25 TW009337] funded by the Fogarty International Center and the National Institute of Mental Health; National Institutes of Health T32 Ruth L. Kirschstein National Research Service Award [grant number 5T32AI007433-22]; the Massachusetts General Hospital Center for Global Health; Harvard University Center for AIDS Research, an NIH funded program [grant number P30 AI060354], which is supported by Fogarty/NIMH R25 TW009337; NIH/NIAID 5T32AI007433-22; the Massachusetts General Hospital Center for Global Health; NIH P30 AI060354; NIMH K23 MH09916; the Sullivan Family Foundation; National Institutes of Health [grant number K23 MH09916].
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/mm3, 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, Pâ€‰=â€‰0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, Pâ€‰=â€‰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 (Pâ€‰=â€‰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.
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Bebell, L. M., Ngonzi, J., Siedner, M. J., Muyindike, W. R., Bwana, B. M., Riley, L. E., ... & Bassett, I. V. (2018). HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda. AIDS care, 1-11.