Gynaecological Surgery in the Hiv-Positive Patient: Women Bear The Brunt Of HIV Disease

In 2003, UNAIDS estimated that 17 million women worldwide were living with HIV/AIDS. It is estimated that every day in sub-Saharan Africa approximately 5 500 women are newly infected with HIV and more than 3 000 die from AIDS-related illnesses. In this region, where women comprise 58% of the existing HIV-positive patients, infection is increasing faster among women than men. The clinician caring for the HIV-infected woman must be alert to the gynaecological issues that are prevalent in this population. The HIV-seropositive patient has a high risk of developing conditions that require emergency laparotomies, e.g. tubo-ovarian abscesses and postpartum endometritis. With the advent of triple antiretroviral therapy, women living with HIV can now enjoy longer life spans in relatively good health. Thus, seropositive women are now facing issues around longevity such as perimenopausal bleeding abnormalities, gynaecological surgery for benign conditions of the female genital tract (i.e. uterine fibroids) and gynaecological cancers. There is a paucity of literature about the rate of complications after gynaecological surgery in HIV-infected women, but this can be extrapolated from the obstetric section and other surgical data. The European HIV-in-Obstetrics group reported a post-caesarean section (elective and non-elective) complication rate of 42.7%, mostly from febrile morbidity and anaemia requiring transfusion. (1)