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Review
Copper intrauterine device use and HIV acquisition in women: a systematic review
  1. Philip C Hannaford1,
  2. Angeline Ti2,3,
  3. Tsungai Chipato4,
  4. Kathryn M Curtis2
  1. 1 Centre of Academic Primary Care, University of Aberdeen, Aberdeen, UK
  2. 2 Division of Reproductive Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  3. 3 Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
  4. 4 University of Zimbabwe College of Health Sciences, Harare, Zimbabwe
  1. Correspondence to Dr Philip C Hannaford, Centre of Academic Primary Care, University of Aberdeen, Aberdeen AB25 2ZD, UK; p.hannaford{at}abdn.ac.uk

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.

  • intrauterine devices
  • human immunodeficiency virus
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjsrh-2019-200512

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    Footnotes

    • 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.

    • Patient consent for publication Not required.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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