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.
PIP: Both the International Planned Parenthood Federation and the World Health Organization have warned against use of IUDs in HIV-infected women due to theoretical concerns about pelvic infection and increased blood loss. No published studies have investigated this concern, however. The validity of this recommendation was investigated in a comparative study of 156 HIV-1-infected and 493 non-infected women from two public family planning clinics (Kenyatta National Hospital and Riruta City Clinic) in Nairobi, Kenya, who requested and met local eligibility criteria for IUD insertion. At 1 and 4 months after insertion, information was collected from physicians--blinded as to the patient's HIV status--on IUD-related complications such as pelvic inflammatory disease (PID), removals, expulsions, and pregnancies. Complications were identified in 11 (7.6%) HIV-positive and 37 (7.9%) HIV-negative women. There were only 3 incident cases of PID, 2 of which occurred in HIV-infected women. IUD removal due to pain or infection occurred in 10 (6.9%) HIV-infected and 27 (5.7%) noninfected women. There were no differences in overall IUD complications in HIV-1-infected women by CD4 status (severely, moderately, or mildly immunocompromised). After adjustment for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, multivariate analysis suggested no association between HIV-1 infection and increased risks for overall IUD-related complications (odds ratio (OR), 0.8; 95% confidence interval (CI), 0.4-1.7) or infection-related complications (OR, 1.0; 95% CI, 0.5-2.3). These findings suggest that the IUD may be a safe contraceptive method for appropriately selected HIV-infected women with continuing access to medical services.