# HIV-associated rectovaginal fistulae in children: a single-centre retrospective study in the antiretroviral era

## TL;DR

This study examines the surgical treatment of rectovaginal fistulas in HIV-positive children and finds that viral suppression is key to successful outcomes.

## Contribution

The paper provides insights into surgical management and outcomes of HIV-associated rectovaginal fistulas in children in the antiretroviral era.

## Key findings

- Seven out of nine patients had good outcomes after fistula repair and stoma reversal.
- Failure to maintain viral suppression was significantly linked to fistula recurrence and complications.
- Four patients experienced fistula recurrence, and two developed anal stenosis.

## Abstract

Acquired rectovaginal fistulae (RVF) are a complication of paediatric HIV infection. We report our experience with the surgical management of this condition.

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.

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).

While HIV-associated RVFs remain a challenging condition, successful surgical treatment is possible. Viral suppression is a necessary condition for good outcomes.