Hindawi Publishing Corporation Infectious Diseases in Obstetrics and Gynecology Volume 2006, Article ID 79512, Pages 1–5 DOI 10.1155/IDOG/2006/79512 Clinical Study Postpartum Morbidity Associated With Advanced HIV Disease Judette Louis,1 Mudathiru A. Buhari,2 Dianne Allen,1 Bernard Gonik,1 and Theodore B. Jones1 1 Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Wayne State University, Detroit, MI 48201, USA 2 Department of Internal Medicine, Division of Infectious Diseases, Wayne State University, Detroit, MI 48201, USA Received 28 May 2006; Revised 25 September 2006; Accepted 10 October 2006 Objective. To investigate the postpartum morbidity and postpartum management of febrile morbidity associated with advanced HIV infection. Methods. A case control study of HIV infected women at a tertiary care center during January 2000–June 2005 was performed. Postpartum morbidity was deﬁned as endometritis, blood transfusion, wound complication, readmission, infectious morbidity, or unexpected surgery. Results. Women in Group 1 had AIDS (N = 33), Group 2 were relatively immunocompetent HIV infected women (N = 115), and Group 3 were uninfected women (N = 152). Group 1 was more likely to have a postpartum morbidity (32.3 versus 19.3 and 13.2%, P = .03) and to have postpartum imaging 18.8 versus 7.9 and 2.6%, P = .002. After controlling for potential confounders, cesarean delivery (OR 6.2, 95% CI 2.1–505.5) but not advanced HIV disease was associated with an increased risk of postpartum morbidity. Conclusion. Cesarean delivery and not advanced HIV disease increases the risk of postpartum morbidity in women with AIDS. Copyright © 2006 Judette Louis et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. INTRODUCTION Women are making up an increasing part of the acquired im- mune deﬁciency syndrome (AIDS) epidemic in the United States [1]. In 2001 HIV infection was the 6th leading cause of death among all women aged 25–34 years and the 4th lead- ing cause of death among all women aged 35–44 years. By the end of 2003, women and adolescents represented 22% of the people living with AIDS [1]. With the considerable num- ber of women of childbearing age with AIDS, issues related to pregnancy remain a concern. Initial studies in the ﬁeld of perinatal HIV focused on vertical transmission. As we have made great strides to reduce vertical transmission to less than 2% in the US, there has been an increased focus on maternal health. While childbirth in developed countries is relatively safe, there exists a risk of morbidity. Of signiﬁcance, cesarean sec- tion is associated with an increased risk and, in particu- lar, infectious morbidity [2]. Risk factors for morbidity in- clude prolonged rupture of membranes, obesity, immune suppression, and type of anesthesia, nonelective cesarean de- livery, and a number of vaginal examinations among oth- ers [3]. Women with AIDS are severely immunocompro- mised and may be at increased risk for postpartum morbid- ity. While studies have indicated that the risk may be greater for HIV-infected patients, few studies have estimated the risk among the most immunocompromised of these patients [4]. Further more, no studies have examined the diﬀerence in postpartum management. This study sought to estimate the risk of postpartum morbidity among patients with AIDS compared to more immunocompetent HIV-infected patients and HIV-uninfected women. An additional objective was to determine the impact of their diagnosis on the management of puerperal infections. SUBJECTS AND METHODS This retrospective chart review was approved by the In- stitutional Review Board at Wayne State University. All of the patients delivered at a single urban tertiary care center. Cases consisted of patients with a diagnosis of HIV infec- tion who delivered from January 1, 2000–June 1, 2005. Un- infected controls were selected utilizing a computerized peri- natal database and random number allocation. Charts with incomplete medical records or undocumented HIV testing during the current pregnancy were excluded. Medical charts were reviewed for demographic data, clinical characteris- tics, antenatal course, delivery data, and postpartum man- agement. Among HIV-infected patients, treatment data were recorded including CD4 cell count, HIV-1 RNA viral load measurements, and use of highly active antiretroviral ther- apy (HAART). Group 1 consisted of patients diagnosed with AIDS as deﬁned by a current or prior history of a CD4 cell count < 200 cells/µL or an opportunistic infection [5]. Group