Copper intrauterine device use and HIV acquisition in women: a systematic review

Philip C Hannaford, Angeline Ti, Tsungai Chipato, Kathryn M Curtis

Research output: Contribution to journalReview articlepeer-review

6 Citations (Scopus)
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Abstract

OBJECTIVES: To review systematically copper intrauterine device (Cu-IUD) use and HIV acquisition in women.

METHODS: We searched Pubmed, Embase and the Cochrane Library between database inception and 26 June 2019 for longitudinal studies comparing incident HIV infection among women using an unspecified IUD or Cu-IUD compared with non-hormonal or no contraceptive users, or hormonal contraceptive users. We extracted information from included studies, assessed study quality, and summarised study findings.

RESULTS: From 2494 publications identified, seven met our inclusion criteria. One randomised controlled trial (RCT), judged "informative with few limitations", found no statistically significant differences in HIV risk between users of the Cu-IUD and either intramuscular depot medroxyprogesterone acetate (DMPA-IM) or levonorgestrel implant. One observational study, deemed "informative but with important limitations", found no statistically significant difference in HIV incidence among IUD users compared with women who had tubal ligation or who were not using any contraception. Another "informative but with important limitations" observational study found no difference in HIV incidence between Cu-IUD users and DMPA or norethisterone enanthate injectable, or implant users. An RCT considered "unlikely to inform the primary question" also found no difference in HIV risk between Cu-IUD and progestogen-only injectable users. Findings from the other three "unlikely to inform the primary question" cohort studies were consistent with the more robust studies suggesting no increased risk of HIV acquisition among Cu-IUD users.

CONCLUSION: The collective evidence, including that from a large high-quality RCT, does not indicate an increased risk of HIV acquisition among users of Cu-IUDs.

Original languageEnglish
Pages (from-to)17-25
Number of pages9
JournalAfrican Journal of Reproductive Health
Volume46
Issue number1
Early online date9 Jan 2020
DOIs
Publication statusPublished - Jan 2020

Bibliographical note

Acknowledgements The authors thank Joanna Taliano, MA
MLS, Reference Librarian at CDC for running the search
strategies.
Contributors PH, AT, TC and KC contributed to the planning
of this review. PH, AT, TC and KC conducted the literature
search, screening, and risk of bias assessment. PH wrote
the first draft of the manuscript. All authors contributed to
subsequent drafts and approved the final manuscript.
Funding The authors have not declared a specific grant for this
research from any funding agency in the public, commercial or
not-for-profit sectors.
Disclaimer The findings and conclusions of this report
are those of the authors and do not necessarily represent
the official postion of the Centers for Disease Control
and Prevention, the World Health Organization, or other
institutions with which the authors are affiliated.
Competing interests TC was a member of the ECHO trial
consortium. PCH, KMC, TC participated in the 2019 WHO
Guideline Development Group (GDG) process which assessed
recommendations on contraception for women at high risk of
HIV.

Keywords

  • human immunodeficiency virus
  • intrauterine devices
  • RISK
  • INFECTION
  • HUMAN-IMMUNODEFICIENCY-VIRUS
  • CONTRACEPTIVE METHODS
  • WOMAN SEXUAL TRANSMISSION
  • Humans
  • HIV Infections/diagnosis
  • Incidence
  • Contraception Behavior/trends
  • Adolescent
  • Adult
  • Female
  • Intrauterine Devices, Copper/trends

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