AFRO-NETS> Intrauterine Device Appears Safe for Women with HIV

[David Hock <DHock@fhi.org>]

Intrauterine Device Appears Safe for Women with HIV
---------------------------------------------------

Some women infected with the human immunodeficiency virus (HIV) may 
be able to safely use the intrauterine device (IUD) for family plan-
ning, according to a recent scientific study conducted in Nairobi, 
Kenya.

Researchers at Family Health International (FHI) and the University 
of Nairobi found that HIV-infected women who used the IUD had no more 
complications than women who used the IUD but were not HIV-infected. 
This was true for women who used the device for as long as two years. 

"These are encouraging results," said Dr. Charles Morrison of Family 
Health International, a U.S- based research organization. "One of the 
concerns with IUD use has been that it could result in more complica-
tions among women with HIV. Another concern is that IUDs could result 
in an increased risk of HIV infection for women's partners. These 
studies show that may not be the case." 

In the study, researchers examined the health of two groups of women: 
156 HIV-infected women who received the IUD and 493 women who re-
ceived the IUD but were not infected with HIV. Researchers looked for 
problems after insertion, such as IUD removal due to infection, 
bleeding and pain; expulsion of the IUD; pregnancy; and pelvic in-
flammatory disease (PID), an infectious disease that can cause severe 
pain, infertility, or even death. Research results were highlighted 
in a recent issue of Network, FHI's quarterly science bulletin (on-
line at: 
http://www.fhi.org/en/fp/fppubs/network/v20-1/nt2015.html

The percentage of women reporting overall complications after IUD in-
sertion was almost identical for the two groups - 14.7 among HIV-
positive women and 14.8 among HIV-negative women. The percentage of 
women reporting problems related to some type of infection - includ-
ing pelvic tenderness and IUD removal for infection or pain - was 
10.7 among those who were HIV-positive, and 8.8 percent among those 
who were HIV-negative. While HIV-positive women tended to have 
slightly more problems related to infection, such problems were rare.

In addition to these results, researchers found that the partners of 
HIV-positive women using IUDs were likely not to be at increased risk 
of infection. Because IUDs can cause heavier menstrual bleeding, some 
researchers have expressed concern that IUD use by HIV-infected women 
could increase men's risk of acquiring HIV, due to increased shedding 
of HIV-infected cells from the woman's genital area.

The new study found that there was no increase in HIV cervical shed-
ding among HIV-infected women using IUDs. "The data ... suggest that 
IUD use by HIV-infected women does not appear to make them more in-
fectious to their partners," said Dr. Morrison. 

Currently, the World Health Organization (WHO) recommends that women 
with HIV use another form of contraception if available. WHO also 
says that women who currently have sexually transmitted infections 
(STIs), such as gonorrhoea or chlamydia, not use IUDs until the STI 
has been treated. And WHO says IUDs are not recommended for women who 
are at high risk for contracting STIs or whose partners are at high 
risk for STIs. 

There are several reasons for these recommendations. First, there is 
a concern that HIV-positive women whose immune systems are weakened 
may not be able to fight off further infections caused by the virus. 
Also, health experts believe that if a woman has an STI, the process 
of inserting the IUD can introduce bacteria from the cervix into the 
womb or the fallopian tubes, leading to PID. 

Experts recommend that health workers screen prospective IUD users 
for STIs through laboratory tests, physical examinations and personal 
medical histories. Although PID can be treated with antibiotics, 
women in developing countries may lack access to these drugs, so 
screening is critical.

If a woman has an undiagnosed STI or another type of cervical infec-
tion and she receives an IUD, the chances of her acquiring PID appear 
to be greatest during the first 20 days following insertion. A study 
of more than 23,000 women, conducted by WHO, found that women's risk 
of developing PID dropped dramatically after the 20-day period and 
remained low for up to eight years 1. Other studies, including some 
by FHI, have shown that about 95 percent of women with cervical in-
fections at the time of IUD insertion did not develop PID in the 
months following 2. However, screening women for cervical infections 
or identifying women at risk of cervical infections is important, 
since PID risk is higher for this group of women. PID risks among 
women who do not use the IUD varies, depending on the prevalence of 
STIs in their area.

While current international medical guidelines discourage IUD use for 
HIV-infected women, researchers say the findings from the FHI study 
may eventually offer another option for family planning. Fourteen 
million women worldwide are HIV-infected, many of whom have a criti-
cal need for safe, effective contraception.

"Study findings suggest that the IUD may be a safe contraceptive 
method for women who have been screened for STIs and who have ongoing 
access to medical services," says Dr. Morrison. "Use of an IUD by 
HIV-infected women does not appear to compromise their health."

Endnotes:

1. Farley TM, Rosenberg MJ, Rowe PJ, et al. Intrauterine devices and 
pelvic inflammatory disease: an international perspective. Lancet 
1991; 339(8796): 785-88. 

2. Senei SK, Schulz KF, Lamptey PR, et al. Preventing IUCD-related 
pelvic infection: the efficacy of prophylactic doxycycline at inser-
tion. B J Obset Gynaecol 1990; 97(5): 412-19. 

3. Morrison CS, Dekadde-Kigondu C, Miller WC, et al. Use of sexually 
transmitted disease risk assessment algorithms for selection of in-
trauterine device candidates. Contraception 1999; 59(2): 97-106. 

4. Faundes A, Telles E, Cristofoletti ML, et al. The risk of inadver-
tent intrauterine device insertion in women carriers of endocervical 
Chlamydia trachomatis. Contraception 1998; 58(2): 105-09.

Editor's note: The results of the study in Kenya were reported in the 
most recent issue of Network, FHI's quarterly magazine. The publica-
tion is posted on FHI's Web site:
http://www.fhi.org 

For more information about FHI's research on IUDs see: 
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, 

or e-mail Nash Herndon in FHI's media relations office:
mailto:nherndon@fhi.org
You may fax FHI at +1-919-544-7261.

--
Send mail for the `AFRO-NETS' conference to `afro-nets@usa.healthnet.org'.
Mail administrative requests to `majordomo@usa.healthnet.org'.
For additional assistance, send mail to:  `owner-afro-nets@usa.healthnet.org'.