Todd CS, Jones HE, Langwenya N, et al. - The rates of contraceptive use are lower among women living with HIV (WLHIV) vs noninfected peers, yet there are concerns regarding contraceptive efficacy and interaction with antiretroviral therapy (ART) that complicate counseling. Researchers here performed a comparison of genital tract HIV viral load (gVL), plasma VL (pVL), and intrauterine contraceptive (IUC) continuation between the levonorgestrel intrauterine system (LNG-IUS) and copper intrauterine device (C-IUD) in Cape Town, South Africa. They conducted a double-masked, randomized controlled noninferiority trial, including WLHIV (aged 18–40), not pregnant or desiring pregnancy within 30 months. The participants were screened and treated (as indicated) for reproductive tract infections (RTIs) within 1 month of enrollment, and virologically suppressed using ART or above treatment threshold at enrollment (non-ART). Randomization was performed of 71 non-ART (36 LNG-IUS, 31 C-IUD; 2 declined and 2 were ineligible) and 134 ART-using (65 LNG-IUS, 67 C-IUD; 1 declined and 1 could not complete IUC insertion) women. From participants, genital tract samples were collected by menstrual cup and blood was taken for genital and plasma viral load levels at enrollment and at 3-, 6-, 12-, 18-, and 24-month visits. Analyses revealed no significant difference in change in detectable genital tract viral load among women receiving the LNG-IUS vs C-IUD users; this was observed regardless of ART status. However, IUC removal was more frequent among women receiving the C-IUD vs those receiving the LNG-IUS through the study period. This study is identified to be one of the first work that compared a hormonal to nonhormonal long-acting reversible contraceptive method with genital tract HIV RNA as the primary outcome among WLHIV. Data gained suggest the safety of LNG-IUS comparable to the C-IUD for WLHIV.