Effect of intrauterine device use on cervical shedding of HIV-1 DNA.
OBJECTIVE
Hormonal contraception has been associated with an increased prevalence of cervical shedding of HIV-1 DNA among infected women. We conducted this study to evaluate the effect of the use of an intrauterine device (IUD) on the detection of HIV-1 DNA in cervical secretions.


METHODS
A prospective study of HIV-1-seropositive women undergoing IUD insertion at two public family planning clinics in Nairobi, Kenya.


METHODS
Cervical swab samples were collected before IUD insertion and approximately 4 months thereafter for the detection of HIV-1-infected cells using polymerase chain reaction (PCR) amplification of HIV-1 gag DNA sequences.


RESULTS
Ninety-eight women were enrolled and followed after IUD insertion. The prevalence of HIV-1 DNA cervical shedding was 50% at baseline and 43% at follow-up [odds ratio (OR) 0.8, 95% confidence interval (CI) 0.5-1.2]. There was no statistically significant difference between the baseline and follow-up shedding rates in a multivariate model that controlled for previous hormonal contraceptive use, condom use, cervical ectopy, friable cervix, cervical infections at an interim visit, and CD4 lymphocyte levels (OR 0.6, 95% CI 0.3-1.1).


CONCLUSIONS
The insertion of an IUD did not significantly alter the prevalence of cervical shedding of HIV-1-infected cells. The use of IUDs, in conjunction with condoms, may be an appropriate method of contraception for HIV-1-infected women from the standpoint of potential infectivity to the male partner through exposure to genital HIV-1.
Richardson
B A
BA
Department of Biostatistics, University of Washington, Seattle 98195, USA.
Morrison
C S
CS
Sekadde-Kigondu
C
C
Sinei
S K
SK
Overbaugh
J
J
Panteleeff
D D
DD
Weiner
D H
DH
Kreiss
J K
JK
D000293:Adolescent; D000328:Adult; D002584:Cervix Uteri / Q000378:metabolism / Q000821:virology*; D004279:DNA, Viral / Q000032:analysis; D005260:Female; D015658:HIV Infections / Q000821:virology*; D015497:HIV-1 / Q000235:genetics / Q000502:physiology*; D006801:Humans; D007434:Intrauterine Devices; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D017201:Virus Shedding
D004279:DNA, Viral