Randomised Controlled Trial of Intrauterine Device Safety in women living with HIV

(A report back on Catherine Todd's session - Randomised Controlled Trial of Intrauterine Device Safety in women living with HIV)

Intrauterine contraceptive devices both Copper containg IUD (C-IUD) & progesterone containing IUD (LNG-IUD) are under utilised in HIV high prevalence settings.  LNG-IUD efficacy has been under contraversy with EFV containing ART regimens. 

LNG-IUD has additional therapeutic benefits for dysfunctional bleeding.

This RCT was conducted in South Africa from Oct 2015 to Dec 2017 in HIV positive females aged 18-40 years.  Eligible subjects were stratified by ART use at entry and randomised to an IUD.  Subjects not on ART had CD4 over  ART initiation level and those on ART were suppressed. All had baseline, 6, 12, 18 and 24 months assessments.

IUCD continuation was 74% at 24 months. Expulsion was higher with Cu- IUCD (8% v 1%).  Discontinuation was higher with C-IUD largely due to side effects of pain and bleeding (HR=8.75, 95% CI 3.08-24.8). 

Low pregnancy and PID rates were seen despite a high background repoducive tract infection rateswith no significant differences between the groups.

There was no significant difference in genital HIV RNA shedding or plasma viral load in all four groups which was the primary outcome measure.

Limitations of the study included small sample size, differential discontinuation between the two types of IUD and early sensoring of the pre-ART group when they commenced ART after the first 6 months. 

This RCT information is a very important addition to the existing body of information and is very relevant to all settings.

IUDs are under utilised in Australia for contraception in my view. LNG-IUD also has additional benefits with menstruation.  This RCT (according to the author, the first in this setting)  should encourage  more clinicians  to use IUDs, in  particular LNG-IUDs.  I will most certainly continue to offer  IUDs especially LNG-IUDs to my HIV positive  patients.


Author bio: Mekala Srirajalingam has dual qualifications in Sexual Health Medicine (AChSHM) and Public Health Medicine (FAFPHM) and works at The Ipswich Sexual Health Service, Queensland, Australia .  Mekala also holds the academic title of Senior Lecturer with The University of QLD.