Post-cesarean febrile morbidity in hiv-infected patients

OBJECTIVE: The incidence of post-cesarean febrile morbidity in women with human immuno-deliciency virus (HIV) infection was compared to that of women without evidence oi" HIV infection. STUDY DESIGN: We conducted this retrospective, matched, casecontrol analysis of all women undergoing cesarean delivery at our inner-city institution from Januarv, 1990 to Julv, 1996. All cases of HIV-infected women undergoing cesarean delivery were identified. Controls were matched for length of ruptured membranes, indication for cesarean delivery, history of previous abdominal surgeiy, presence/absence of chorioamnionitis, history of substance abuse, and underlying maternal health. The HIV-infected population was then further stratified as to total T-helper cell (CD4) count and history of azidothvmidine (AZT) use in pregnancy Febrile morbidity was defined as rwo posl-cesarean temperatures >-58.0° centigrade, taken 4 hours apart. Statistical analyses were performed with Fisher's exact and \2 where appropriate. RESULTS: A total of 4166 cesarean deliveries were evaluated. Thirty cases were identified and matched with 90 controls. The post-cesarean febrile morbidity rate was 36.7% for both groups. The institutional postcesarean febrile morbidity rate was 25% for the study period (p = 0.004). The febrile morbidity rale did not differ significantly between the cases and controls undergoing elective cesarean deliveiy. There was no difference in the febrile morbidity rate between HIV-infected women who took AJ.T compared to those HIV-infected women who did not take AZT. Neither a CD4 count <500 nor <200 was associated with a significantly higher incidence of post-operative febrile morbidity. CONCLUSIONS: In contrast to a previous study, our data show that IIIV infection does not increase post-cesarean febrile morbidity rates when stiuh groups are appropriately matched for other known risk factors for postcesavean fever.