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

Sinei S, Morrison CS, Sekadde-Kigondu C, Melissa A, okonya D. "Complications of use of intrauterine devices among HIV-1-infected women.". 2012.


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.
Lancet 1998; 351: 1238–41


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