Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2014

Open Access 01-12-2014 | Research article

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

Authors: Jennifer A Unger, Barbra A Richardson, Phelgona A Otieno, Carey Farquhar, Dalton Wamalwa, Grace C John-Stewart

Published in: BMC Pregnancy and Childbirth | Issue 1/2014

Login to get access

Abstract

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.
Appendix
Available only for authorised users
Literature
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-PubMed
2.
World Health Organization., UNAIDS., UNICEF: Global HIV/AIDS Response: Epidemic Update and Health Sector Progress Towards Universal Access: Progress Report 2011. 2011, Geneva: World Health Organization
3.
Ferrero S, Bentivoglio G: Post-operative complications after caesarean section in HIV-infected women. Arch Gynecol Obstet. 2003, 268 (4): 268-273.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMedPubMedCentral
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.CrossRefPubMed
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.PubMedPubMedCentral
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.CrossRefPubMed
16.
National Council for Population and Development (Kenya), Kenya. Central Bureau of Statistics., Macro International: Kenya Demographic and Health Survey, 1998. 1999, Nairobi, Kenya Calverton, Md. USA: National Council for Population and Development : Central Bureau of Statistics Macro International
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
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.CrossRefPubMed
Metadata
Title
Mode of delivery and postpartum HIV-1 disease progression and mortality in a Kenyan cohort
Authors
Jennifer A Unger
Barbra A Richardson
Phelgona A Otieno
Carey Farquhar
Dalton Wamalwa
Grace C John-Stewart
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2014
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/1471-2393-14-257

Other articles of this Issue 1/2014

BMC Pregnancy and Childbirth 1/2014 Go to the issue

Research article

Considerations of private sector obstetricians on participation in the state led “Chiranjeevi Yojana” scheme to promote institutional delivery in Gujarat, India: a qualitative study

Research article

Cost-effectiveness of strategies to improve the utilization and provision of maternal and newborn health care in low-income and lower-middle-income countries: a systematic review

Research article

“A patchwork of services” – caring for women who sustain severe perineal trauma in New South Wales – from the perspective of women and midwives

Study protocol

Care-related factors associated with antepartal diagnosis of intrauterine growth restriction: a case–control study

Research article

Can a text message a week improve breastfeeding?

Research article

Women’s views and experiences of antenatal care in Iraq: a Q methodology study