OBJECTIVE To examine complications in HIV-positive women and controls undergoing gynecologic surgery and to evaluate the prognostic value of immune function for postoperative morbidity. METHODS A review of patients undergoing surgery by the gynecology faculty at the Johns Hopkins Medical Institutions from February 1994 through November 1998 was performed. Fifty-three HIV-positive women were matched with 58 controls. Information on demographics, medical conditions, indication for surgery, surgery, blood loss, length of stay, perioperative hemoglobins, postoperative white blood cell counts and complications was collected. Data on HIV clinical stage, immune function and use of HIV medications were collected for HIV-positive patients. Odds ratio and chi 2 or two-sided t tests were used. Complication rates were also compared by CD4 counts and by HIV RNA levels. RESULTS The only difference in demographics was by type of insurance (P < .001). Overall, 9 of 53 HIV-positive women had a complication as compared with 5 of 58 controls. There was no difference in the overall rate of complications or in specific complications, even when stratified by minor or major procedures. There were no differences between CD4 and HIV RNA groups for individual complications. CONCLUSIONS The study found no differences in complications between HIV-positive and control patients and no association with immune status or viral load.