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Effect of intrauterine device use on cervical shedding of HIV-1 DNA

Richardson, Barbra A.a; Morrison, Charles S.b; Sekadde-Kigondu, Christinec; Sinei, Samuel K.c; Overbaugh, Juliea; DeVange Panteleeff, Danaa; Weiner, Debra H.b; Kreiss, Joan K.a

Clinical: Original Papers

Objective: Hormonal contraception has been associated with an increased prevalence of cervical shedding of HIV-1 DNA among infected women. We conducted this study to evaluate the effect of the use of an intrauterine device (IUD) on the detection of HIV-1 DNA in cervical secretions.

Design: A prospective study of HIV-1-seropositive women undergoing IUD insertion at two public family planning clinics in Nairobi, Kenya.

Methods: Cervical swab samples were collected before IUD insertion and approximately 4 months thereafter for the detection of HIV-1-infected cells using polymerase chain reaction (PCR) amplification of HIV-1 gag DNA sequences.

Results: Ninety-eight women were enrolled and followed after IUD insertion. The prevalence of HIV-1 DNA cervical shedding was 50% at baseline and 43% at follow-up [odds ratio (OR) 0.8, 95% confidence interval (CI) 0.5-1.2]. There was no statistically significant difference between the baseline and follow-up shedding rates in a multivariate model that controlled for previous hormonal contraceptive use, condom use, cervical ectopy, friable cervix, cervical infections at an interim visit, and CD4 lymphocyte levels (OR 0.6, 95% CI 0.3-1.1).

Conclusion: The insertion of an IUD did not significantly alter the prevalence of cervical shedding of HIV-1-infected cells. The use of IUDs, in conjunction with condoms, may be an appropriate method of contraception for HIV-1-infected women from the standpoint of potential infectivity to the male partner through exposure to genital HIV-1.

From the aDepartments of Biostatistics, Microbiology, Medicine, and Epidemiology, University of Washington, Seattle, Washington, USA; bFamily Health International, Research Triangle Park, NC, USA; and cDepartment of Obstetrics and Gynaecology, University of Nairobi, Nairobi, Kenya.

Disclaimer: The views expressed in this article do not necessarily reflect those of Family Health International (FHI), the US Agency for International Development (USAID), or the American Foundation for AIDS Research (AmFAR).

Sponsorship: This work was supported by FHI with funds from USAID and from AmFAR (grant no. 02243-16-RG).

Corresponding author and requests for reprints: Barbra Richardson, Box 359909, University of Washington, Seattle, WA 98195, USA.

Received: 26 January 1999; revised: 1 July 1999; accepted: 26 July 1999.

© 1999 Lippincott Williams & Wilkins, Inc.