Complications of use of intrauterine devices among HIV-1-infected women.
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.


RESULTS
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.


CONCLUSIONS
Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.
Sinei
S K
SK
Department of Obstetrics and Gynaecology, University of Nairobi, Kenya.
Morrison
C S
CS
Sekadde-Kigondu
C
C
Allen
M
M
Kokonya
D
D
D000328:Adult; D018791:CD4 Lymphocyte Count; D005260:Female; D015658:HIV Infections / Q000276:immunology; D015497:HIV-1; D006801:Humans; D007433:Intrauterine Device Expulsion; D007434:Intrauterine Devices / Q000009:adverse effects*; D015999:Multivariate Analysis; D000292:Pelvic Inflammatory Disease / Q000209:etiology; D011247:Pregnancy; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000209:etiology