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HIV Infection and risk of postpartum infection, complications and mortality in rural Uganda

机译：乌干达农村感染，并发症和死亡率的艾滋病毒感染和风险

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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/mm(3), 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, P=0.49). However, more HIV-infected women developed postpartum complications (4.4% vs. 1.2%, P=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 (P=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.
机译：HIV感染可能会增加产后感染和感染有关的死亡率的风险。我们假设Mbarara的产后感染发病率和可归因的死亡率，乌干达在艾滋病毒感染的艾滋病毒感染者比艾滋病毒无感染妇女更高。我们在2015年举办了4231名妇女的预期队列研究，以便于2015年出发，以便送货或产后护理。住院期间，所有发热或低温妇女和随机选择的常温妇女的子集，并在突发的手机面试中进行了6周。主要结果是在医院产后感染。二次结果包括院内并发症（死亡率，重新运行，重症监护单位转移，需要成像或输血）和6周死亡率。我们进行了多变量的回归分析，以估计HIV Serostatus每种结果的调整差异。平均年龄为25.2岁，481名参与者（11％）是艾滋病毒感染的。中位CD4 +计数为487（IQR 325,696）细胞/ mm（3），90％的艾滋病毒感染妇女（193/215选择用于深入调查）是抗逆转录病毒治疗。总体而言，5％（205/4231）妇女发烧或体温过低。累积的医院后产后感染发病率为2.0％，并且HIV状态没有差异（AOR 1.4,95％CI 0.6-3.3，P = 0.49）。然而，更多的艾滋病毒感染的妇女发育出产后并发症（4.4％vs.1.2％，p = 0.001）。在医院死亡率罕见（2/1768,0.1％），仍然如此6周（4/1526,0.3％），没有HIV Serostatus（P = 1.0和0.31分别）差异。对于乌干达农村妇女的妇女具有高抗逆转录病毒治疗覆盖率，HIV感染未预测产后感染或死亡率，但与产后并发症的风险增加有关。

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