***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE : To compare discontinuation rates of the levonorgestrel and copper intrauterine devices ( IUDs ) among women with human immunodeficiency virus . METHODS : A double-masked r and omized trial was conducted at Mulago Hospital , Ug and a. Women received either a copper or levonorgestrel IUD . The primary outcome was discontinuation of intrauterine contraception within 1 year of placement . The secondary outcomes were incidence of side effects and severe adverse events . To discern a difference of 10 % from a copper IUD discontinuation rate of 18 % , power of 80 % , and 95 % confidence interval ( CI ) , a sample size of 351 per arm was estimated . Analysis of the primary outcome was by intension-to-treat principle . RESULTS : From September 2013 to December 2014 , 979 were screened and 703 r and omized as follows : 349 to the copper group and 354 to the levonorgestrel group . In total , 8.6 % ( 29/338 ) women in the copper group compared with 8.1 % ( 27/334 ) in the levonorgestrel group discontinued intrauterine conception within 1 year of placement ( incidence rate ratio 1.1 [ 95 % CI 0.64–1.96 ] ) . Overall , the incidence of heavy bleeding was higher in the copper group ( 37 % [ 125/338 ] ) than in the levonorgestrel group ( 19.5 % [ 65/334 ] ) . However , the incidence of amenorrhea , which occurred in 3.3 % ( 11/338 ) of women , was lower in the copper group than the 19.8 % ( 66/334 ) of women who reported amenorrhea in the levonorgestrel group . CONCLUSION : There was no difference in discontinuation rates between the copper and levonorgestrel devices . Women in the levonorgestrel group had reduced incidence of heavy bleeding and a higher incidence of amenorrhea compared with those in the copper group . CLINICAL TRIAL REGISTRATION : Pan African Clinical Trial Registry , www.pactr.org , PACTR 201308000561212 . LEVEL OF EVIDENCE : Objective : To determine the effect of cryotherapy on HIV-1 cervical shedding . Design : Prospect i ve cohort study . Methods : Five hundred HIV-positive women enrolled at an HIV treatment clinic in Nairobi , Kenya were screened for cervical cancer . Women diagnosed with cervical intraepithelial neoplasia stage 2 or 3 ( CIN 2/3 ) by histology were offered cryotherapy treatment . The first 50 women had cervical swabs taken at baseline and at 2 and 4 weeks following treatment . Swabs were analyzed for HIV-1 RNA and compared using General Estimating Equation ( GEE ) with binomial or Gaussian links . Results : Of the 50 women enrolled , 40 were receiving antiretroviral therapy ( ART ) and 10 were not receiving ART at the time of cryotherapy and during study follow-up . Among all women , the odds of detectable cervical HIV-1 RNA did not increase at 2 weeks [ odds ratio ( OR ) 1.18 ; 95 % confidence interval ( CI ) 0.65–2.13 ] or 4 weeks ( OR 1.29 ; 95 % CI 0.71–2.33 ) following cryotherapy . Among 10 women not receiving ART , the OR of detectable shedding at 2 weeks was higher , but not statistically significant ( OR 4.02 ; 95 % CI 0.53–30.79 ; P = 0.2 ) , and at 4 weeks remained unchanged ( OR 1.00 ; 95 % CI 0.27–3.74 ) . Conclusion : There was no increase in detectable cervical HIV-1 RNA among HIV-positive women after cryotherapy . The risk of HIV-1 transmission after cryotherapy may not be significant , particularly among women already on ART at the time of cervical treatment . However , further investigation is needed among women not receiving ART OBJECTIVE To assess outcome in HIV-positive women undergoing the loop electrosurgical excision procedure ( LEEP ) .  METHOD A prospect i ve study was conducted with 789 out patients undergoing LEEP at Chiang Mai University Hospital between October 2004 and June 2008 . RESULTS The 70 HIV-positive women ( 8.9 % ) were younger ( P<0.001 ) and had a lower parity ( P<0.001 ) than the remaining women . The proportion of women undergoing LEEP for persistent low- grade lesions was higher ( 8.6 % vs 1.9 % ) and the prevalence of margin involvement was higher ( 60.0 % vs 49.4 % ) among the HIV-positive women . After adjusting for age , parity , menopausal status , size of excised lesion , and histopathologic result , HIV infection was not significantly associated with LEEP complications ( adjusted odds ratio , 0.41 ; 95 % confidence interval , 0.15 - 1.15 ) . CONCLUSION The higher risk of resection margin involvement in HIV-infected women was not associated with LEEP complications STUDY QUESTION Does laboratory testing after syndromic screening for sexually transmitted infections ( STIs ) reduce the rate of intrauterine contraception ( IUC ) removal among women living with HIV/AIDS ( WLHA ) ? SUMMARY ANSWER Additional laboratory testing after syndromic screening for STIs did not affect the likelihood that a woman would remove an IUC immediately or within 1 year of IUC use or the frequency of post-insertion unscheduled clinic visits . In low-risk WLHA , the incidence rate of IUC removal is low with or without laboratory testing . WHAT IS KNOWN ALREADY Fear of infectious morbidity remains an obstacle to uptake of IUC by WLHA . The value of laboratory testing after syndromic screening for STI before the insertion of IUC remains uncertain . STUDY DESIGN , SIZE , DURATION We enrolled WLHA from 2 September to 6 December 2013 and followed them up to 31 December 2014 . After syndromic screening , 703 women free of STIs were r and omized to either additional laboratory screening or no additional screening for STI before IUC insertion . The r and omization sequence was generated by an independent statistician and r and omization numbers placed in opaque sequentially numbered sealed envelopes . All women r and omized had an IUC inserted and in all 672 participants completed the 1-year follow-up . The study staff who followed up the participants were blinded to the study allocation groups . Incidence rate ratios ( IRRs ) were used to compare the incidence rates of IUC removal , unscheduled clinic attendance and IUC continuation between the two groups . PARTICIPANTS / MATERIAL S , SETTING , METHODS Women eligible to participate were 18 - 49 years old at study entry , in a relationship with a male partner , wanted to avoid pregnancy for at least 1 year and were undergoing HIV/AIDS care at Mulago Hospital , Ug and a. Participants completed a baseline question naire and up to four follow-up question naires until discontinuation of IUC , loss to follow-up or end of study observation after 12 months . MAIN RESULTS AND THE ROLE OF CHANCE The rate of IUC removal was 8.8 % ( 29/331 ) in the no additional screening group and 8.0 % ( 27/341 ) in the additional laboratory screening group [ IRR 1.1 ( 95 % CI 0.63 - 1.93 ) ] . Unscheduled clinic attendances were similar in the two groups at 1 year of IUC insertion : 13.6 % ( 45/331 ) in the no additional screening group and 12.3 % ( 42/241 ) in the additional laboratory screening group . During the 1-year follow-up , only five women , three from the no additional screening group and two from the additional laboratory screening group , developed pelvic inflammatory disease ( PID ) , as defined by established diagnostic criteria . LIMITATIONS , REASONS FOR CAUTION We were not able to carry out STI risk assessment directly from the men thus women with high-risk partners could have been included in the study and this may be responsible for the lack of a demonstrable effect of additional laboratory screening on incidence rates of IUC removals and unscheduled clinic attendance . The diagnosis of PID was based on clinical signs and symptoms ; therefore , sub clinical PID could have been missed . WIDER IMPLICATION S OF THE FINDINGS Among WLHA , the incidence rate of IUC removal is low and IUC continuation high . Syndromic screening for STIs could be sufficient in indentifying WLHA who are suitable for IUC use . However , our findings are only generalizable to women in HIV/AIDS care who have access to good follow-up . STUDY FUNDING /COMPETING INTERESTS The study was supported by Medical Education for Equitable Services to all Ug and ans , a Medical Education Partnership Initiative grant number 5R24TW008886 from the office of Global AIDS Coordinator and the US Department of Health and Human Services , Health Re sources and Services Administration and National Institutes of Health . Additional funding was from the Swedish International Development Agency , Swedish Research Council ( SIDA/VR ) . The authors have no competing interests to declare . TRIAL REGISTRATION NUMBER This trial was registered at Pan African Clinical Trial , Registry . PACTR 201308000561212 BACKGROUND Plasma HIV-1 RNA concentration has been the best predictor for risk of heterosexual and perinatal transmission . However , direct contact with HIV-1 present locally in the genital tract might be necessary for transmission . We aim ed to assess the relation between HIV-1 shedding ( RNA or culturable virus ) in female genital secretions and other factors that might affect HIV-1 shedding . METHODS This was a cross-sectional study within the Women 's Interagency HIV Study ( WIHS ) , a prospect i ve longitudinal cohort study of HIV-infected women . We enrolled 311 HIV positive women from Jan 30 , 1997 to July 1 , 1998 . We did clinical assessment s , cultured HIV-1 , and measured RNA in peripheral blood mononuclear cells  ( P BMC ) and genital secretions . We compared the results with univariate and multivariate analyses . Presence of HIV-1 RNA or culturable virus in genital secretions was defined as HIV-1 shedding . FINDINGS HIV-1 RNA was present in genital secretions of 57 % ( 152/268 ) of women whereas infectious virus was detected only in 6 % ( 17/271 ) . Genital tract HIV-1 shedding was found in 80 % ( 130/163 ) of women with detectable plasma RNA and 78 % ( 116/148 ) of women with positive P BMC cultures . 33 % ( 27/83 ) of women with less than 500 copies/mL plasma RNA and 39 % ( 35/90 ) of those with negative P BMC cultures also had genital tract shedding . INTERPRETATION Plasma RNA concentration , both qualitatively and quantitatively , was the most important factor in predicting genital HIV-1 shedding , even among women receiving potent antiretroviral therapy . However , HIV-1 shedding did occur in women with less than 500 copies/mL plasma HIV-1 RNA . This finding suggests that a separate reservoir of HIV-1 replication may exist in some women BACKGROUND The effects of estrogen-containing contraceptives on disease activity in women with systemic lupus erythematosus have not been determined . METHODS We conducted a single-blind clinical trial involving 162 women with systemic lupus erythematosus who were r and omly assigned to combined oral contraceptives , a progestin-only pill , or a copper intrauterine device ( IUD ) .  Disease activity was assessed at 0 , 1 , 2 , 3 , 6 , 9 , and 12 months according to the Systemic Lupus Erythematosus Disease Activity Index ( SLEDAI ) . The primary outcome was global disease activity , which we estimated by measuring the area under the SLEDAI curve . Secondary outcomes included the maximum SLEDAI score , change in SLEDAI score , incidence of lupus flares , median time to first flare , systemic lupus erythematosus treatment , and adverse events . The results were analyzed by the intention-to-treat method . RESULTS At baseline , all demographic features and disease characteristics were similar in the three groups . The mean ( + /-SD ) SLEDAI score was 6.1+/-5.6 in the group assigned to combined oral contraceptives , 6.4+/-4.6 in the group assigned to the progestin-only pill , and 5.0+/-5.3 in the group assigned to the IUD ( 54 patients in each group ) ( P=0.36 ) . Disease activity remained mild and stable in all groups throughout the trial . There were no significant differences among the groups during the trial in global or maximum disease activity , incidence or probability of flares , or medication use . The median time to the first flare was three months in all groups . Thromboses occurred in four patients ( two in each of the two groups receiving hormones 
    Output:
    
The remaining studies generally found low or no incidence of PID among IUD users .
No direct evidence addresses potential differences in HIV disease progression or transmission by HIV disease severity .
CONCLUSION Limited evidence of fair to poor quality found no differences in infectious complications when comparing IUD complication rates among women with varying levels of HIV disease severity .
One study found that IUD use was not associated with HIV transmission , and studies generally found no differences in genital viral shedding or disease progression ; however , there was little direct evidence to address potential differences related to HIV severity