BACKGROUND: A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infected women based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infected women than in non-infected women. METHODS: 649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians. FINDINGS: Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infected women, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out. INTERPRETATION: Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.
BACKGROUND: A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infectedwomen based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infectedwomen than in non-infected women. METHODS: 649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians. FINDINGS: Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infectedwomen, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out. INTERPRETATION: Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infectedwomen with continuing access to medical services.
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Keywords:
Acquired Immunodeficiency Syndrome; Africa; Africa South Of The Sahara; Case Control Studies; Contraception; Contraception Termination; Contraceptive Methods--complications; Developing Countries; Diseases; Eastern Africa; English Speaking Africa; Family Planning; Hiv Infections; Incidence; Infections; Iud--complications; Kenya; Measurement; Pelvic Infections--prevention and control; Pelvic Inflammatory Disease--prevention and control; Reproductive Tract Infections; Research Methodology; Research Report; Studies; Viral Diseases
Authors: Sten H Vermund; José A Tique; Holly M Cassell; Megan E Pask; Philip J Ciampa; Carolyn M Audet Journal: J Acquir Immune Defic Syndr Date: 2013-06-01 Impact factor: 3.731
Authors: Lisa B Haddad; Caryl Feldacker; Denise J Jamieson; Hannock Tweya; Carrie Cwiak; Amy G Bryant; Mina C Hosseinipour; Thomas Chaweza; Linly Mlundira; Fanny Kachale; Gretchen S Stuart; Irving Hoffman; Sam Phiri Journal: Int J Gynaecol Obstet Date: 2014-05-13 Impact factor: 3.561
Authors: Elizabeth M Stringer; Christine Kaseba; Jens Levy; Moses Sinkala; Robert L Goldenberg; Benjamin H Chi; Inutu Matongo; Sten H Vermund; Mulindi Mwanahamuntu; Jeffrey S A Stringer Journal: Am J Obstet Gynecol Date: 2007-08 Impact factor: 8.661