%0 Journal Article
%T HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era.
%A Alberti P
%A Westgarth-Taylor C
%A Trovalusci E
%A Charlton R
%A Brisighelli G
%J Pediatr Surg Int
%V 40
%N 1
%D 2024 Jul 8
%M 38976031
%F 2.003
%R 10.1007/s00383-024-05762-5
%X <B>OBJECTIVE: </B>Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.<BR><B>METHODS: </B>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.<BR><B>RESULTS: </B>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).<BR><B>CONCLUSIONS: </B>While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.