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. 2020 Jan;46(1):17-25.
doi: 10.1136/bmjsrh-2019-200512.

Copper intrauterine device use and HIV acquisition in women: a systematic review

Philip C Hannaford  1 , Angeline Ti  2   3 , Tsungai Chipato  4 , Kathryn M Curtis  2
Affiliations

Copper intrauterine device use and HIV acquisition in women: a systematic review

Philip C Hannaford et al. BMJ Sex Reprod Health. 2020 Jan.

Abstract

Objectives: To review systematically copper intrauterine device (Cu-IUD) use and HIV acquisition in women.

Methods: We searched Pubmed, Embase and the Cochrane Library between database inception and 26 June 2019 for longitudinal studies comparing incident HIV infection among women using an unspecified IUD or Cu-IUD compared with non-hormonal or no contraceptive users, or hormonal contraceptive users. We extracted information from included studies, assessed study quality, and summarised study findings.

Results: From 2494 publications identified, seven met our inclusion criteria. One randomised controlled trial (RCT), judged "informative with few limitations", found no statistically significant differences in HIV risk between users of the Cu-IUD and either intramuscular depot medroxyprogesterone acetate (DMPA-IM) or levonorgestrel implant. One observational study, deemed "informative but with important limitations", found no statistically significant difference in HIV incidence among IUD users compared with women who had tubal ligation or who were not using any contraception. Another "informative but with important limitations" observational study found no difference in HIV incidence between Cu-IUD users and DMPA or norethisterone enanthate injectable, or implant users. An RCT considered "unlikely to inform the primary question" also found no difference in HIV risk between Cu-IUD and progestogen-only injectable users. Findings from the other three "unlikely to inform the primary question" cohort studies were consistent with the more robust studies suggesting no increased risk of HIV acquisition among Cu-IUD users.

Conclusion: The collective evidence, including that from a large high-quality RCT, does not indicate an increased risk of HIV acquisition among users of Cu-IUDs.

Keywords: human immunodeficiency virus; intrauterine devices.

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Conflict of interest statement

Competing interests: TC was a member of the ECHO trial consortium. PCH, KMC, TC participated in the 2019 WHO Guideline Development Group (GDG) process which assessed recommendations on contraception for women at high risk of HIV.

Figures

Figure 1
Figure 1
Identification of included studies.
Figure 2
Figure 2
Intrauterine device use and risk of HIV acquisition in “informative with few limitations” or “informative but with important limitations” studies. *Estimates are the inverse associations of those reported by the authors. adjHR, adjusted hazard ratio; CI, confidence interval; Cu-IUD, copper intrauterine device; DMPA, depot medroxyprogesterone acetate; HR, hazard ratio; ITT, intention-to-treat; LNG, levonorgestrel; NET-EN, norethisterone enanthate
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