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Journal Watch Women's Health
December 27, 2005
Male Circumcision Reduces HIV Risk
Posted 01/13/2006
Summary
Observational studies from Africa have shown that circumcised men are less likely to become infected with HIV. However, because of confounding by sexual practices, the causal relation between circumcision and protection against HIV infection has been difficult to determine. These investigators randomized 3128 uncircumcised, HIV-seronegative men (age range, 18-24) in South Africa to circumcision or to observation followed by circumcision at the end of the study. The procedures were performed in local practitioners' offices, and participants were followed up at 3, 12, and 21 months.
The study was terminated early, after a planned interim analysis showed significant efficacy for circumcision. Overall, during a mean 18 months of follow-up, 20 HIV infections occurred among circumcised men and 49 among uncircumcised men — representing a significant 60% decrease in HIV risk. About 4% of circumcised participants had adverse events related to the surgery, none serious. At the end of the study, only four circumcised men were dissatisfied with the appearance of their penis. Circumcised men reported somewhat higher risk behavior during the study, and fewer clinic visits for genital problems.
Comment
Sexual transmission is the most common mode of HIV spread worldwide. Aside from abstinence and consistent condom use, methods for HIV prevention have been elusive, and an effective vaccine has not been developed. Consistent with findings from this randomized clinical trial, a meta-analysis of observational studies also has shown a 60% lower risk for HIV acquisition among circumcised men (AIDS 2000; 14:2361). However, how to scale up use of this intervention, and its acceptability among various groups, remains unknown.
— Anna Wald, MD, MPH
Source
Auvert B et al. Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: The ANRS 1265 trial. PLoS Med 2005 Nov; 2:e298.
