Changes in genital tract immune cell populations after initiation of intrauterine contraception.
OBJECTIVE
The primary target cells for the human immunodeficiency virus (HIV) infection in the genital tract are CD4 T cells that express CCR5 on the surface. Alterations in genital tract T cells that express CCR5 could impact HIV acquisition risk. We hypothesized that, when compared with baseline, the use of a hormonal intrauterine device (IUD) would alter HIV target cells (primarily CCR5+ CD4 cells) in the female genital tract more than a nonhormonal IUD.


METHODS
Thirty-four healthy HIV-negative women aged 18-40 years who were seeking an IUD for contraception were assigned randomly to receive a levonorgestrel IUD or a copper T380A IUD. A parallel group of 8 control women who did not need contraception was also enrolled. Genital tract mucosal immune cell populations that were collected by cervical cytobrush and endometrial biopsy before and 2 months after IUD placement were analyzed by flow cytometry. Mean differences in cell number and percent that expressed receptors from baseline to follow-up examination were evaluated with the use of paired Student t tests.


RESULTS
Neither IUD altered the number of T cells within the upper and lower genital tracts. Levonorgestrel IUD users had a decrease in T cells that expressed the HIV coreceptor CCR5 in the endometrium and cervix after 2 months of use compared with baseline. There was a decrease in activated endometrial T cells in levonorgestrel IUD users and a decrease in activated cervical T cells in copper IUD users after 2 months of IUD use, compared with baseline.


CONCLUSIONS
Women who use IUDs have reduced expression of the CCR5 HIV coreceptor on T cells in the endometrium and cervix compared with expression before IUD placement. These findings suggest that susceptibility to HIV infection would not be increased by IUD use.
Magee-Womens Research Institute, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA. Electronic address: achisx@upmc.edu.
Sharon L
SL
Achilles
Magee-Womens Research Institute, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA; Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA.
Mitchell D
MD
Creinin
Magee-Womens Research Institute, Pittsburgh, PA.
Kevin A
KA
Stoner
Magee-Womens Research Institute, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Beatrice A
BA
Chen
Magee-Womens Research Institute, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Leslie
L
Meyn
Magee-Womens Research Institute, Pittsburgh, PA; Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA.
Sharon L
SL
Hillier
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D015496:CD4-Positive T-Lymphocytes / Q000378:metabolism*; D002584:Cervix Uteri / Q000276:immunology*; D004717:Endometrium / Q000276:immunology*; D005260:Female; D015658:HIV Infections / Q000635:transmission*; D006801:Humans; D007435:Intrauterine Devices, Copper; D007436:Intrauterine Devices, Medicated; D019713:Receptors, CCR5 / Q000378:metabolism*; D055815:Young Adult
C584933:CCR5 protein, human; D019713:Receptors, CCR5
CCR5; HIV; IUD; T cell; hormonal contraception