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Complications of use of intrauterine devices among HIV-1-infected women.
Lancet. 1998 Apr 25; 351(9111):1238-41.Lct

Abstract

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.

Authors+Show Affiliations

Department of Obstetrics and Gynaecology, University of Nairobi, Kenya.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

9643743

Citation

Sinei, S K., et al. "Complications of Use of Intrauterine Devices Among HIV-1-infected Women." Lancet (London, England), vol. 351, no. 9111, 1998, pp. 1238-41.
Sinei SK, Morrison CS, Sekadde-Kigondu C, et al. Complications of use of intrauterine devices among HIV-1-infected women. Lancet. 1998;351(9111):1238-41.
Sinei, S. K., Morrison, C. S., Sekadde-Kigondu, C., Allen, M., & Kokonya, D. (1998). Complications of use of intrauterine devices among HIV-1-infected women. Lancet (London, England), 351(9111), 1238-41.
Sinei SK, et al. Complications of Use of Intrauterine Devices Among HIV-1-infected Women. Lancet. 1998 Apr 25;351(9111):1238-41. PubMed PMID: 9643743.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Complications of use of intrauterine devices among HIV-1-infected women. AU - Sinei,S K, AU - Morrison,C S, AU - Sekadde-Kigondu,C, AU - Allen,M, AU - Kokonya,D, PY - 1998/6/27/pubmed PY - 1998/6/27/medline PY - 1998/6/27/entrez KW - Acquired Immunodeficiency Syndrome KW - Africa KW - Africa South Of The Sahara KW - Case Control Studies KW - Contraception KW - Contraception Termination KW - Contraceptive Methods--complications KW - Developing Countries KW - Diseases KW - Eastern Africa KW - English Speaking Africa KW - Family Planning KW - Hiv Infections KW - Incidence KW - Infections KW - Iud--complications KW - Kenya KW - Measurement KW - Pelvic Infections--prevention and control KW - Pelvic Inflammatory Disease--prevention and control KW - Reproductive Tract Infections KW - Research Methodology KW - Research Report KW - Studies KW - Viral Diseases SP - 1238 EP - 41 JF - Lancet (London, England) JO - Lancet VL - 351 IS - 9111 N2 - 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. SN - 0140-6736 UR - https://www.unboundmedicine.com/medline/citation/9643743/Complications_of_use_of_intrauterine_devices_among_HIV_1_infected_women_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0140-6736(97)10319-1 DB - PRIME DP - Unbound Medicine ER -