Is the intrauterine device appropriate contraception for HIV-1-infected women?

Objective To assess whether the risk of complications is higher in HIV-1-in fected women compared with noninfected women in the two years following ins ertion of the intrauterine contraceptive device. Design Prospective cohort study. Population Six hundred and forty-nine women (156 HIV-1-infected, 493 non-in fected) in Nairobi, Kenya who requested an intrauterine contraceptive devic e and met local eligibility criteria. Methods We gathered information on complications related to the use of the intrauterine contraceptive device, including pelvic inflammatory disease, r emovals due to infection, pain or bleeding, expulsions, and pregnancies at one,. four, and 24 months after insertion by study physicians masked to par ticipants' HIV-1 status. Cox regression was used to estimate hazard ratios. Results Complications were identified in 94 of 636 women returning for foll ow up (14.7% of HIV-1-infected, 14.8% of non-infected). The incidence of pe lvic inflammatory disease was rare in both infected (2.0%) and non-infected (0.4%) groups. Multivariate analyses suggested no association between HIV- 1 infection and increased risk of overall complications (hazard ratio = 1.0 ; 95% CI 0.6-1.6). Infection-related complications (e.g. any pelvic tendern ess, removal for infection or pain) were also similar between groups (10.7% of HIV-1-infected, 8.8% of non-infected; P = 0.50), although there was a n on-significant increase in infection-related complications among HIV-1-infe cted women with use of the intrauterine contraceptive device longer than fi ve months (hazard ratio = 1.8; 95% CI 0.8-4.4). Neither overall nor infecti on-related complications differed by CD4 (immune) status. Conclusions HIV-1-infected women often have a critical need for safe and ef fective contraception. The intrauterine contraceptive device, may be an app ropriate contraceptive method for HIV-1-infected women with ongoing access to medical services.