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Caesarean section trends among 48 688 women living with and without HIV in Brazil: a cohort study
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  • Lanbo Yang,
  • Mary Catherine Cambou,
  • Eddy Segura,
  • Marineide Gonçalves de Melo,
  • Breno Santos,
  • Ivana Rosângela dos Santos Varella,
  • Karin Nielsen-Saines
Lanbo Yang
Brown University
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Mary Catherine Cambou
David Geffen School of Medicine
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Eddy Segura
Universidad de Huanuco
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Marineide Gonçalves de Melo
Hospital Nossa Senhora da Conceição
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Breno Santos
Hospital Nossa Senhora da Conceição
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Ivana Rosângela dos Santos Varella
Hospital Nossa Senhora da Conceição
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Karin Nielsen-Saines
David Geffen School of Medicine
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Abstract

Objective: To evaluate caesarean section (CS) rates in women with and without HIV and frequency of mother-to-child HIV transmission. Design: Retrospective cohort study. Setting: Tertiary hospital in south Brazil, epicenter of the country’s HIV epidemic. Population or Sample: Women-infant pairs delivering at one institution between 1/1/2008 to 12/31/2018 Methods: Data was extracted from hospital records CS frequencies were compared using Pearson’s chi-squared test. CS predictors were evaluated by multivariate log-linear Poisson regression using a generalized estimating equations approach. HIV viral suppression (VS) was defined as virus load (VL) of <1000 copies/ml at delivery. HIV MTCT was determined according to national guidelines. Main Outcome Measures: C-section, HIV mother-to-child transmission (MTCT). Results: Over 11 years, 48,688 pregnancies occurred in 40,375 women; HIV seroprevalence was 2.7%; 18,886 (38.8%) CS were performed; 47.7% of WLH and 38.6% of women without HIV (WWOH) had CS, p<0.001. Although HIV was a risk factor for CS (aRR: 1.17 [1.05-1.29]), WLH with VS achieved similar CS rates (36.7%) as WWOH (39.8%) by 2018. CS in WLH with unknown VL at delivery (42.6%) did not increase over time. HIV MTCT rate was 2.2%, highest in WLH with unknown VL (8.4%) versus WLH without VS (4.1%) and WLH with VS (0.5%; p<0.001). Conclusion: In the HIV epicenter of Brazil, WLH with VS had less surgical deliveries, likely due to potent combination antiretroviral use. Nearly half of WLH with unknown VL, did not undergo CS, a potential missed opportunity for HIV PMTCT.