title: The levonorgestrel-releasing intrauterine system (LNG-IUS) in HIV-infected women--effects on bleeding patterns, ovarian function and genital shedding of HIV.
abstract: BACKGROUND
  Safe and effective contraceptives are needed for human immunodeficiency virus (HIV)-infected women. The levonorgestrel-releasing intrauterine system (LNG-IUS) is a highly effective contraceptive with additional health benefits. The objective of this study was to evaluate the effects of the LNG-IUS among HIV-infected women.
  
  
  METHODS
  Twelve systematically managed HIV-infected women were studied prospectively. Following a 2-month run-in period, the subjects had an LNG-IUS inserted and were followed up for 1 year. Patterns of bleeding, blood haemoglobin and CD4-lymphocyte content, plasma HIV RNA, serum levels of LNG, of estradiol (E(2)) and of ferritin and genital shedding of HIV RNA were monitored.
  
  
  RESULTS
  Menstrual bleeding was reduced significantly during the use of the LNG-IUS; this was associated with slight increases in serum haemoglobin and ferritin levels. Serum E(2) concentrations remained in the follicular range in all subjects. Among subjects using antiretroviral medication, the proportion of cervicovaginal lavage specimens with detectable HIV RNA was 10% before and after the insertion of the LNG-IUS.
  
  
  CONCLUSIONS
  The effects of the LNG-IUS on bleeding patterns, body iron stores and ovarian function were similar to those seen in healthy women. Genital shedding of HIV RNA was not affected by the LNG-IUS. These data encourage further studies on the effects of the LNG-IUS on reproductive health among HIV-infected women.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Helsinki, Finland. oskari.heikinheimo@helsinki.fi
authors.forename: Oskari
authors.initials: O
authors.lastname: Heikinheimo
authors.forename: Päivi
authors.initials: P
authors.lastname: Lehtovirta
authors.forename: Jukka
authors.initials: J
authors.lastname: Suni
authors.forename: Jorma
authors.initials: J
authors.lastname: Paavonen
mesh_terms: D003271:Contraceptive Agents, Female / Q000494:pharmacology*; D004958:Estradiol / Q000097:blood; D005260:Female; D006678:HIV / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D015658:HIV Infections / Q000503:physiopathology*; D006801:Humans; D016912:Levonorgestrel / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology*; D008598:Menstruation / Q000187:drug effects* / Q000502:physiology; D010053:Ovary / Q000187:drug effects* / Q000503:physiopathology; D011446:Prospective Studies; D014599:Uterus / Q000187:drug effects*; D019562:Viral Load; D017201:Virus Shedding / Q000187:drug effects*
chemical_list: D003271:Contraceptive Agents, Female; D004958:Estradiol; D016912:Levonorgestrel