Mode of delivery and postpartum HIV-1 disease progression and mortality in a Kenyan cohort

BMC Pregnancy and Childbirth

Grace C John-Stewart⁵  Dalton Wamalwa²  Carey Farquhar³  Phelgona A Otieno¹  Barbra A Richardson⁶  Jennifer A Unger⁴ 

[1] Centre for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya;Department of Pediatrics, University of Nairobi, Nairobi, Kenya;Department of Epidemiology, University of Washington, Seattle, Washington, USA;Department of Obstetrics and Gynecology, University of Washington, Harborview Medical Center, Box 359865, 325 Ninth Ave, Seattle, Washington 98195, USA;Department of Pediatrics, University of Washington, Seattle, Washington, USA;Department of Global Health, University of Washington, Seattle, Washington, USA

关键词: Maternal mortality;    HIV-1 disease progression;    Cesarean section;    Mode of delivery;    HIV;   

Others  :  1125730
DOI  :  10.1186/1471-2393-14-257

 received in 2013-10-08, accepted in 2014-07-21,  发布年份 2014

【 摘 要 】

Background

There are limited data on the impact of cesarean section delivery on HIV-1 infected women in Sub-Saharan Africa. The purpose of this study was to assess the effect of mode of delivery on HIV-1 disease progression and postpartum mortality in a Kenyan cohort.

Methods

A prospective cohort study was conducted in Nairobi, Kenya from 2000–2005. We determined changes in CD4⁺ counts, HIV-1 RNA levels and mortality during the first year postpartum between HIV-1 infected women who underwent vaginal delivery (VD), non-scheduled cesarean section (NSCS) and scheduled cesarean section (SCS) and received short-course zidovudine. Loess curves and multivariate linear mixed effects models were used to compare longitudinal changes in maternal HIV-1 RNA and CD4⁺ counts by mode of delivery. Kaplan Meier curves, the log rank test, and Cox proportional hazards regression were used to assess difference in mortality.

Results

Of 501 women, 405 delivered by VD, 74 delivered by NSCS and 22 by SCS. Baseline characteristics were similar between the VD and NSCS groups. Baseline antenatal CD4⁺ counts were lowest and HIV-1 RNA levels highest in the NSCS group but HIV-1 RNA levels were similar between groups at delivery. The rate of decline in CD4⁺ cells and rate of increase in HIV-1 RNA did not differ between groups. After adjusting for confounders, women who underwent NSCS had a 3.39-fold (95% CI 1.11, 10.35, P = 0.03) higher risk of mortality in the first year postpartum compared to women with VD.

Conclusions

Non-scheduled cesarean section was an independent risk factor for postpartum mortality in HIV-1 positive Kenyan women. The cause of death was predominantly due to HIV-1 related infections, and not direct maternal deaths, however, this was not mirrored by differential changes in HIV-1 progression markers between the groups.

【 授权许可】

   
2014 Unger et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Read JS, Newell MK: Efficacy and safety of cesarean delivery for prevention of mother-to-child transmission of HIV-1. Cochrane Database Syst Rev 2005, 4:CD005479.
• [2]World Health Organization., UNAIDS., UNICEF: Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access: Progress Report 2011. Geneva: World Health Organization; 2011.
• [3]Ferrero S, Bentivoglio G: Post-operative complications after caesarean section in HIV-infected women. Arch Gynecol Obstet 2003, 268(4):268-273.
• [4]Lapaire O, Irion O, Koch-Holch A, Holzgreve W, Rudin C, Hoesli I: Increased peri- and post-elective cesarean section morbidity in women infected with human immunodeficiency virus-1: a case-controlled multicenter study. Arch Gynecol Obstet 2006, 274(3):165-169.
• [5]Fiore S, Newell ML, Thorne C: Higher rates of post-partum complications in HIV-infected than in uninfected women irrespective of mode of delivery. AIDS 2004, 18(6):933-938.
• [6]Marcollet A, Goffinet F, Firtion G, Pannier E, Le Bret T, Brival ML, Mandelbrot L: Differences in postpartum morbidity in women who are infected with the human immunodeficiency virus after elective cesarean delivery, emergency cesarean delivery, or vaginal delivery. Am J Obstet Gynecol 2002, 186(4):784-789.
• [7]Duarte G, Read JS, Gonin R, Freimanis L, Ivalo S, Melo VH, Marcolin A, Mayoral C, Ceriotto M, de Souza R, Cardoso E, Harris DR, NISDI Perinatal Study Group: Mode of delivery and postpartum morbidity in Latin American and Caribbean countries among women who are infected with human immunodeficiency virus-1: the NICHD International Site Development Initiative (NISDI) Perinatal Study. Am J Obstet Gynecol 2006, 195(1):215-229.
• [8]Read JS, Tuomala R, Kpamegan E, Zorrilla C, Landesman S, Brown G, Vajaranant M, Hammill H, Thompson B: Mode of delivery and postpartum morbidity among HIV-infected women: the women and infants transmission study. J Acquir Immune Defic Syndr 2001, 26(3):236-245.
• [9]Urbani G, de Vries MM, Cronje HS, Niemand I, Bam RH, Beyer E: Complications associated with cesarean section in HIV-infected patients. Int J Gynaecol Obstet 2001, 74(1):9-15.
• [10]Navas-Nacher EL, Read JS, Leighty RM, Tuomala RE, Zorrilla CD, Landesman S, Rosenblatt H, Hershow RC: Mode of delivery and postpartum HIV-1 disease progression: the Women and Infants Transmission Study. AIDS 2006, 20(3):429-436.
• [11]The European Collaborative Study: Caesarean section and risk of vertical transmission of HIV-1 infection. The European Collaborative Study. Lancet 1994, 34(8911):1464-1467.
• [12]John-Stewart GC, Mbori-Ngacha D, Payne BL, Farquhar C, Richardson BA, Emery S, Otieno P, Obimbo E, Dong T, Slyker J, Nduati R, Overbaugh J, Rowland-Jones S: HV-1-specific cytotoxic T lymphocytes and breast milk HIV-1 transmission. J Infect Dis 2009, 199(6):889-898.
• [13]Shaffer N, Chuachoowong R, Mock PA, Bhadrakom C, Siriwasin W, Young NL, Chotpitayasunondh T, Chearskul S, Roongpisuthipong A, Chinayon P, Karon J, Mastro TD, Simonds RJ: Short-course zidovudine for perinatal HIV-1 transmission in Bangkok, Thailand: a randomised controlled trial. Bangkok Collaborative Perinatal HIV Transmission Study Group. Lancet 1999, 353(9155):773-780.
• [14]Emery S, Bodrug S, Richardson BA, Giachetti C, Bott MA, Panteleeff D, Jagodzinski LL, Michael NL, Nduati R, Bwayo J, Kreiss JK, Overbaugh J: Evaluation of performance of the Gen-Probe human immunodeficiency virus type 1 viral load assay using primary subtype A, C, and D isolates from Kenya. J Clin Microbiol 2000, 38(7):2688-2695.
• [15]Oyieke JB, Obore S, Kigondu CS: Millennium development goal 5: a review of maternal mortality at the Kenyatta National Hospital, Nairobi. East Afr Med J 2006, 83(1):4-9.
• [16]National Council for Population and Development (Kenya), Kenya. Central Bureau of Statistics., Macro International: Kenya Demographic and Health Survey, 1998. Nairobi, Kenya Calverton, Md. USA: National Council for Population and Development : Central Bureau of Statistics Macro International; 1999.
• [17]Horberg MA, Hurley LB, Klein DB, Follansbee SE, Quesenberry C, Flamm JA, Green GM, Luu T: Surgical outcomes in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy. Arch Surg 2006, 141(12):1238-1245.
• [18]Hazenberg MD, Otto SA, van Benthem BH, Roos MT, Coutinho RA, Lange JM, Hamann D, Prins M, Miedema F: Persistent immune activation in HIV-1 infection is associated with progression to AIDS. AIDS 2003, 17(13):1881-1888.
• [19]Marik PE, Flemmer M: The immune response to surgery and trauma: Implications for treatment. J Trauma Acute Care Surg 2012, 73(4):801-808.
• [20]Fahey JL, Taylor JM, Detels R, Hofmann B, Melmed R, Nishanian P, Giorgi JV: The prognostic value of cellular and serologic markers in infection with human immunodeficiency virus type 1. N Engl J Med 1990, 322(3):166-172.