1. HIV co-receptor CCR5 expression was reduced in endometrial and cervical T-cells following hormonal intrauterine device (IUD) insertion.
2. T-cell activation was decreased in the endometrium of levonorgestrel IUD users but increased in the cervix of copper IUD users.
Evidence Rating Level: 2 (Good)
Study Rundown: This study found that IUD insertion was associated with decreased expression of HIV co-receptor CCR5 in genital tract immune cells. In- and ex- vivo studies have suggested that exposure to sex hormones may increase CCR5 expression, but there is limited literature on the influence of hormonal contraception. The present work is the first study to examine the influence of IUDs on genital tract immune cells.
Limitations of this study include small sample size and short follow-up period. Large scale cohort studies and randomized controlled trials evaluating incidence of HIV among IUD users are needed to confirm this study’s findings and support the hypothesis that IUD use may be protective against HIV.
In-Depth [randomized controlled trial]: This study assessed changes in cervical and endometrial immune cells in women randomized to receive a copper IUD (Cu-IUD) (n=16) or levonorgestrel IUD (LNG-IUD) (n=15). A control group receiving no IUD (n=8) was also included. Outcomes evaluated included cell numbers; expression of the CCR5 HIV co-receptor; and expression of CD69, reflecting T-cell activation.
The number of CD14+ innate immune cells in the endometrium increased in the Cu-IUD group (p<0.001). Endometrial CD8+ T-cell expression of CCR5 decreased for both IUD groups (p<0.005). CCR5 expression was also decreased in CD4+ T-cells in the endocervix of both IUD groups (p<0.05 for LNG-IUD, p<0.01 for Cu-IUD) and the endometrium of women with a LNG-IUD (p<0.001). CD69 expression was decreased in endometrial CD8+ T-cells in women with a LNG-IUD (p<0.05). Among women with a Cu-IUD, CD69 expression was increased in cervical CD4+ and CD8+ T-cells (p<0.01, p<0.05 respectively).
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