A randomized trial of the intrauterine contraceptive device vs hormonal contraception in women who are infected with the human immunodeficiency virus.
OBJECTIVE
The purpose of this study was to determine whether the intrauterine contraceptive device (IUD) is effective and safe among women who are infected with the human immunodeficiency virus (HIV).


METHODS
We randomly assigned 599 postpartum, HIV-infected women in Zambia to receive either a copper IUD or hormonal contraception and followed them for at least 2 years.


RESULTS
Women who were assigned randomly to hormonal contraception were more likely to become pregnant than those who were assigned randomly to receive an IUD (rate, 4.6/100 vs 2.0/100 woman-years; hazards ratio, 2.4; 95% CI, 1.3-4.7). One woman who was assigned to the IUD experienced pelvic inflammatory disease (crude rate, 0.16/100 woman-years; 95% CI, 0.004-868); there was no pelvic inflammatory disease among those women who were assigned to hormonal contraception. Clinical disease progression (death or CD4+ lymphocyte count dropping below 200 cells/microL) was more common in women who were allocated to hormonal contraception (13.2/100 woman-years) than in women who were allocated to the IUD (8.6/100 woman-years; hazard ratio, 1.5; 95% CI, 1.04-2.1).


CONCLUSIONS
The IUD is effective and safe in HIV-infected women. The unexpected observation that hormonal contraception was associated with more rapid HIV disease progression requires urgent further study.
Stringer
Elizabeth M
EM
Centre for Infectious Disease Research in Zambia, Lusaka, Zambia. eli@uab.edu
Kaseba
Christine
C
Levy
Jens
J
Sinkala
Moses
M
Goldenberg
Robert L
RL
Chi
Benjamin H
BH
Matongo
Inutu
I
Vermund
Sten H
SH
Mwanahamuntu
Mulindi
M
Stringer
Jeffrey S A
JS
D000328:Adult; D018791:CD4 Lymphocyte Count; D003278:Contraceptives, Oral, Hormonal / Q000009:adverse effects / Q000494:pharmacology*; D018450:Disease Progression; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000635:transmission; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007434:Intrauterine Devices / Q000009:adverse effects; D011247:Pregnancy
D003278:Contraceptives, Oral, Hormonal
Contraception. 1999 Aug;60(2):57-63
10592851
Obstet Gynecol. 1983 Jan;61(1):113-4
6218430
JAMA. 2001 May 9;285(18):2347-54
11343482
Contraception. 1985 Apr;31(4):331-49
4006467
Am J Public Health. 1993 May;83(5):705-10
8484453
Obstet Gynecol. 1996 Sep;88(3 Suppl):41S-47S
8752227
Lancet. 1998 Apr 25;351(9111):1238-41
9643743
Contraception. 1998 Sep;58(3 Suppl):45S-53S; quiz 70S
9807692
AIDS Rev. 2004 Jul-Sep;6(3):131-43
15595430
Sex Transm Infect. 2005 Apr;81(2):184-5
15800107
Contraception. 2005 Sep;72(3):187-91
16102553
Lancet. 2006 Apr 1;367(9516):1066-74
16581405
Sex Transm Dis. 2006 Jun;33(6):350-6
16505747
JAMA. 2006 Aug 16;296(7):782-93
16905784
AIDSlink. 1995 Mar-Apr;(32):12-3
12346005
Int J Fertil Womens Med. 2002 Mar-Apr;47(2):87-95
11991435
AIDS. 2003 Jun 13;17(9):1377-82
12799559
Stud Fam Plann. 1999 Dec;30(4):315-28
10674327