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Safety of intrauterine devices among women with HIV: a systematic review
Journal article   Peer reviewed

Safety of intrauterine devices among women with HIV: a systematic review

Naomi K. Tepper, Kathryn M. Curtis, Kavita Nanda and Denise J. Jamieson
Contraception (Stoneham), Vol.94(6), pp.713-724
12/01/2016
DOI: 10.1016/j.contraception.2016.06.011
PMCID: PMC11034836
PMID: 27343750
url
https://www.ncbi.nlm.nih.gov/pmc/articles/11034836View
Open Access

Abstract

Use of highly effective contraception among women living with HIV is critical to prevent unintended pregnancy and subsequent risk of maternal complications and perinatal HIV transmission. However, it is not known whether use of intrauterine devices (IUDs) among women with advanced HIV disease poses an increased risk of pelvic infection or HIV progression and transmission. To identify evidence regarding the risk of pelvic infection, HIV disease progression or HIV transmission among women with HIV using IUDs and whether this risk differs by severity of HIV disease. We searched the PubMed database for all articles published from database inception through January 2016. For the outcome of pelvic infection, we included studies that examined women using IUDs and reported risk of pelvic inflammatory disease (PID) or pelvic infections among women with varying levels of HIV severity or among women with HIV compared with women without HIV. For the outcomes of HIV disease progression and HIV transmission to noninfected male partners, we included studies of women with HIV using IUDs compared with other contraceptive methods or no method. The review identified eight articles from six study populations which addressed pelvic infections or other IUD-related complications and found mixed results. One study that directly compared women with varying levels of HIV disease severity found no differences in complication rates between those with severe or mild disease after short- and longer-term follow-up. The remaining studies generally found low or no incidence of PID among IUD users. Among eight articles from seven study populations that reported on HIV disease progression, there were generally no differences between women using IUDs compared with other contraceptives, nor were there changes between baseline and follow-up. One article that reported directly on HIV disease transmission to noninfected male partners found no difference in HIV disease transmission, and five articles found no differences in genital viral shedding among women using IUDs. No direct evidence addresses potential differences in HIV disease progression or transmission by HIV disease severity. Limited evidence of fair to poor quality found no differences in infectious complications when comparing IUD complication rates among women with varying levels of HIV disease severity. One study found that IUD use was not associated with HIV transmission, and studies generally found no differences in genital viral shedding or disease progression; however, there was little direct evidence to address potential differences related to HIV severity.
 HIV Intrauterine device Pelvic inflammatory disease Systematic review

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