Sinei S K, Morrison C S, Sekadde-Kigondu C, Allen M, Kokonya D
Department of Obstetrics and Gynaecology, University of Nairobi, Kenya.
Lancet. 1998 Apr 25;351(9111):1238-41. doi: 10.1016/S0140-6736(97)10319-1.
A WHO expert group and the International Planned Parenthood Federation recommend against use of intrauterine devices (IUDs) in HIV-1-infected women based on theoretical concerns about pelvic infection and increased blood loss. We investigated whether the risk of complications after IUD insertion is higher in HIV-1-infected women than in non-infected women.
649 (156 HIV-1 infected 493 non-infected) women in Nairobi, Kenya, who requested and met local eligibility criteria for insertion of an IUD were enrolled. We gathered information on IUD-related complications, including pelvic inflammatory disease, removals due to infection, pain, or bleeding, expulsions, and pregnancies at 1 and 4 months after insertion. Patients' HIV-1 status was masked from physicians.
Complications were identified in 48 of 615 women (11 [7.6%] HIV-1-infected women, 37 [7.9%] non-infected). Incident pelvic inflammatory disease (two [1.4%] HIV-1 infected, one [0.2%] non-infected) and infection-related complications (any tenderness, removal of IUD for infection or pain; ten [6.9%] HIV-1 infected, 27 [5.7%] non-infected) were also rare and similar in the two groups. Complication rates were similar by CD4 (immune) status. Multivariate analyses suggested no association between HIV-1 infection and increased risks for overall complications (odds ratio 0.8 [95% CI 0.4-1.7]) or infection-related complications (1.0 [0.5-2.3]), adjusted for marital status, study site, previous IUD use, ethnic origin, and frequency of sexual intercourse, but a slight increase cannot be ruled out.
Our data suggest that IUDs may be a safe contraceptive method for appropriately selected HIV-1-infected women with continuing access to medical services.
世界卫生组织专家小组和国际计划生育联合会基于对盆腔感染和失血增加的理论担忧，建议艾滋病毒-1感染女性不要使用宫内节育器（IUD）。我们调查了艾滋病毒-1感染女性放置宫内节育器后发生并发症的风险是否高于未感染女性。
在肯尼亚内罗毕，649名（156名艾滋病毒-1感染女性，493名未感染女性）要求并符合当地宫内节育器放置资格标准的女性被纳入研究。我们收集了与宫内节育器相关并发症的信息，包括盆腔炎、因感染、疼痛或出血而取出节育器、节育器排出以及放置后1个月和4个月时的妊娠情况。医生对患者的艾滋病毒-1感染状况不知情。
615名女性中有48名发生了并发症（11名[7.6%]艾滋病毒-1感染女性，37名[7.9%]未感染女性）。盆腔炎（2名[1.4%]艾滋病毒-1感染女性，1名[0.2%]未感染女性）和与感染相关的并发症（任何压痛、因感染或疼痛取出宫内节育器；10名[6.9%]艾滋病毒-1感染女性，27名[5.7%]未感染女性）也很罕见，且两组相似。按CD4（免疫）状态划分的并发症发生率相似。多变量分析表明，在对婚姻状况、研究地点、以前使用宫内节育器的情况、种族和性交频率进行校正后，艾滋病毒-1感染与总体并发症风险增加（比值比0.8[95%置信区间0.4-1.7]）或与感染相关的并发症风险增加（1.0[0.5-2.3]）之间无关联，但不能排除有轻微增加的可能性。
我们的数据表明，对于经过适当选择且能持续获得医疗服务的艾滋病毒-1感染女性，宫内节育器可能是一种安全的避孕方法。
