Few Complications with IUD Use Among HIV-1-Infected Women
July 1, 1998 3 minutes read
Few Complications with IUD Use Among HIV-1-Infected Women
ABSTRACT & COMMENTARY
Synopsis: IUD use among selected HIV-infected women is not associated with increased complications.
Source: Sinei SK, et al. Lancet 1998;351:1238-1241.
A total of one thousand six hundred eighty-six women from Nairobi had IUDs inserted in family planning clinics, and were invited to participate in this study. All women who had IUDs inserted met eligibility criteria by having a negative history for the following conditions and events: ectopic pregnancy, recent pregnancy, leiomyomata, active PID, malignant reproductive tract disease, structural abnormality, copper allergy, active cervicitis, abnormal vaginal bleeding, and high risk for STD. Some of the women who had IUDs inserted were HIV positive. The health care worker inserting the IUD did not know the HIV status of the study participant. Six hundred forty-nine women (156 HIV-infected and 493 non-infected controls) agreed to participate in the study. Samples were obtained from all study participants for HIV. At one month, the patients returned to the clinic for a complication history and follow-up examination. At this visit, chlamydia, gonorrhea, and C4 lymphocyte tests were also performed, and another visit was scheduled at four months. A similar history and examination was performed, but additional laboratory samples were obtained only if the patient had a history of problems, or positive findings.
Most of the women enrolled in the study were parous, married, and aged 20-30 years. The HIV-infected women were more likely to be single, had a different ethnic distribution, had more partners with STDs in the previous year, were less active sexually, and were more likely to have cervical "edema," friability, and discharge. There was no significant difference in the rates of overall complications, pelvic inflammatory disease, infection-related complications, or overall IUD complaints.
Sinei et al suggest that the widely held belief that women who are infected with HIV should not use an IUD as a method of contraception needs to be re-examined. However, they point out that their study did not have sufficient power to determine whether there was a difference in PID, though no increase among HIV-infected women was observed. In addition, only 9% of the infected women were severely immunocompromised.
COMMENT BY KENNETH NOLLER, MD
Because we do not regularly publish "Letters to the Editor" in OB/GYN Clinical Alert, few readers are probably aware that the editors do receive letters from readers from time to time. A few praise us, some disagree in some way with our comments, and authors of articles that we have "slammed" write angry retorts. I expect that I may get a letter or two from readers asking me why in the world I chose this article to review, since no physician in North America would consider placing an IUD in an HIV-infected woman, and, thus, the article has no clinical usefulness.
I did have a purpose in my choice of an article for this month. Regular readers will know that I have several times expressed my bias that the IUD is unfortunately, woefully underused in North America as a method of contraception. It is effective, inexpensive when compared to other methods, and, among appropriately selected women, may well be safer than several other forms of contraception. Therefore, I specifically chose this article to demonstrate that, even in this "high-risk" group of HIV-infected women, the IUD performed remarkably well. It would have been preferable had the study been reported after a longer period of follow-up, but, even with only four months of data, the remarkably low rate of complications is impressive.
I hope more physicians will consider the use of an IUD in monogamous women with a low-risk profile.
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