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

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

doi:10.1136/bmjsrh-2019-200512

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 journal › Review article › peer-review

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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 language	English
Pages (from-to)	17-25
Number of pages	9
Journal	African Journal of Reproductive Health
Volume	46
Issue number	1
Early online date	9 Jan 2020
DOIs	https://doi.org/10.1136/bmjsrh-2019-200512
Publication status	Published - Jan 2020

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

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Hannaford_CopperIntrauterineDevice_VOR
Copyright information © Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 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/.
Final published version, 482 KBLicence: CC BY-NC

Cite this

@article{c1fc165c89eb44fd8c2337c92d869625,

title = "Copper intrauterine device use and HIV acquisition in women: a systematic review",

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.",

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",

author = "Hannaford, {Philip C} and Angeline Ti and Tsungai Chipato and Curtis, {Kathryn M}",

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.",

year = "2020",

month = jan,

doi = "10.1136/bmjsrh-2019-200512",

language = "English",

volume = "46",

pages = "17--25",

journal = "African Journal of Reproductive Health",

issn = "1118-4841",

publisher = "Women's Health and Action Research Centre",

number = "1",

}

TY - JOUR

T1 - Copper intrauterine device use and HIV acquisition in women

T2 - a systematic review

AU - Hannaford, Philip C

AU - Ti, Angeline

AU - Chipato, Tsungai

AU - Curtis, Kathryn M

N1 - 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.

PY - 2020/1

Y1 - 2020/1

N2 - 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.

AB - 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.

KW - human immunodeficiency virus

KW - intrauterine devices

KW - RISK

KW - INFECTION

KW - HUMAN-IMMUNODEFICIENCY-VIRUS

KW - CONTRACEPTIVE METHODS

KW - WOMAN SEXUAL TRANSMISSION

KW - Humans

KW - HIV Infections/diagnosis

KW - Incidence

KW - Contraception Behavior/trends

KW - Adolescent

KW - Adult

KW - Female

KW - Intrauterine Devices, Copper/trends

UR - http://www.scopus.com/inward/record.url?scp=85077687623&partnerID=8YFLogxK

U2 - 10.1136/bmjsrh-2019-200512

DO - 10.1136/bmjsrh-2019-200512

M3 - Review article

C2 - 31919240

VL - 46

SP - 17

EP - 25

JO - African Journal of Reproductive Health

JF - African Journal of Reproductive Health

SN - 1118-4841

IS - 1

ER -

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

Abstract

Keywords

UN SDGs

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