Twenty-four studies were included in the review (n=10,395 participants), only one of which was an RCT. The number of participants in the included studies ranged from six to 4,109. Most studies were conducted in low-income countries. Most studies were deemed poor or fair quality; only one study was deemed good quality.
HIV disease progression (nine studies, n=7,633): Eight observational studies found no effects of hormonal or intrauterine contraceptives on HIV disease progression measures, which included CD4 cell count, HIV RNA levels and survival. One RCT found that compared with copper IUD, hormonal contraceptive users had a significantly increased risk of falling bellow a CD4 cell count of 200 cells/μL or death.
Adverse health outcomes (10 studies, n=1,991): Three observational studies found an increased risk of STDs with hormonal contraceptive; one observational study found no difference. Two studies that examined PID found no effect with copper IUDs. Two studies of LNG-IUD found no adverse events. Two studies found no adverse effects apart from irregular bleeding with Norplant users.
HIV infectivity (10 studies, n=1,613): One study found no effect of oral contraceptives or copper IUD on female to male transmission. Seven studies examined the influence of hormonal contraceptive use on HIV-1 DNA or RNA shedding and showed mixed effects of contraceptive use. Four studies of copper IUDs showed no increase in viral shedding.