HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era
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In brief
In brief
This retrospective study examines surgical outcomes for HIV-associated rectovaginal fistulae in 10 pediatric patients. Viral suppression was significantly associated with successful repair, with 7/9 patients achieving good outcomes after staged surgical management including diverting colostomy and definitive repair.
- HIV-associated rectovaginal fistulae in children typically present around age 2 years and require staged surgical repair with diverting colostomy.
- Fistula recurrence occurred in 44% of cases, with complications including anal stenosis and perineal sepsis being common postoperatively.
- Viral suppression is critical for successful outcomes—failure to maintain suppression was significantly associated with fistula recurrence.
- Ischiorectal fat pad interposition was used in over half of repairs as part of the reconstructive approach.
- Despite challenges, 78% of patients achieved good functional outcomes without soiling after staged repair and stoma reversal.
Written by the GCMD Library team from the article.
Abstract
Purpose
Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.
Methods
We retrospectively reviewed the records of paediatric patients with HIV-associated RVF managed at Chris Hani Baragwanath Academic Hospital (2011–2023). Information about HIV management, surgical history, and long-term outcomes was collected.
Results
Ten patients with HIV-associated RVF were identified. Median age of presentation was 2 years (IQR: 1–3 years). Nine patients (9/10) underwent diverting colostomy, while one demised before the stoma was fashioned. Fistula repair was performed a median of 17 months (IQR: 7.5–55 months) after colostomy. An ischiorectal fat pad was interposed in 5/9 patients. Four (4/9) patients had fistula recurrence, 2/9 patients developed anal stenosis, and 3/9 perineal sepsis. Stoma reversal was performed a median of 16 months (IQR: 3–25 months) after repair. Seven patients (7/9) have good outcomes without soiling, while 2/9 have long-term stomas. Failure to maintain viral suppression after repair was significantly associated with fistula recurrence and complications (φ = 0.8, p < 0.05).
Conclusion
While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.