Women living with HIV need to know which contraceptive methods are safe for them to use both in terms of their own health and in terms of the likelihood of increasing transmission to their sexual partners. Some evidence suggests that some forms of hormonal contraception may increase the risk of transmission to sexual partners by increasing genital viral shedding.
Global use of intrauterine devices (IUDs), including the hormonal IUD, the levonorgestrel intrauterine system (LNG-IUS), has increased over the last decade. However, there are few trials comparing the safety of the LNG-IUS with that of the copper intrauterine device (C- IUD) among women living with HIV and none focusing specifically on their impact on HIV.
To investigate, CUNY SPH Associate Professor Heidi Jones and colleagues at FHI-360 and the University of Cape Town implemented a randomized controlled trial in Cape Town, South Africa among 199 women living with HIV. The results were published recently in PLOS Medicine.
Participants had genital tract samples collected and blood taken for genital and plasma viral load levels at enrollment and at 3-, 6-, 12-, 18-, and 24-month visits. Women using the LNG-IUS did not have any significant increase in detectable genital tract HIV viral load compared with C-IUD users. Women in the study were more likely to discontinue the C-IUD compared to the LNG-IUS due to side effects.
“Our study suggests that LNG-IUS is as safe as the C-IUD for women living with HIV and will strengthen international medical eligibility guidelines,” Jones says. “Many women living with HIV may prefer the LNG-IUS compared to the C-IUD, and this method should be included as an option among the full spectrum of contraceptive methods available to them worldwide.”
This study is among the first comparing a hormonal to nonhormonal long-acting reversible contraceptive method with genital tract HIV RNA as the primary outcome among women living with HIV.