UCSF

Objective

To evaluate the association between HIV infection and puerperal sepsis among women in Zimbabwe.

Methods

A subanalysis was performed using data from a prospective cohort study conducted between September 2, 2014, and July 1, 2015, at two tertiary hospitals in Zimbabwe. Eligible participants were consecutive women who met the WHO criteria for puerperal sepsis. Variables assessed included HIV-infection status and the use of antiretroviral therapy. Severity of immunosuppression was defined by the number of T cells that expressed cluster of differentiation 4 (CD4). Endocervical swabs and blood samples were collected for microbial culture and susceptibility testing.

Results

In all, 33 (21.9%) of the 151 women included in the present analysis had HIV. Among women with HIV, severe immunosuppression (CD4-positive T cell count <200/mm³ ) was associated with a mean hospital stay of 19.0 days versus 10.2 days for mild-advanced immunosuppression (CD4-positive T cell count 200-500/mm³ ) and insignificant immunosuppression (CD4-positive T cell count >500/mm³ ; P=0.030). Use of antiretroviral therapy did not independently influence clinical outcomes. Furthermore, infection with HIV did not influence the microorganisms isolated from blood or endocervical samples.

Conclusion

Severe immunosuppression was associated with increased length of hospitalization among women with HIV who had puerperal sepsis.