Circumcision of HIV-infected men does not reduce HIV transmission to female partners

July 16, 2009

A randomised trial in Uganda has shown that circumcision of HIV-infected men does not reduce HIV transmission to female partners. The findings are reported in an Article in this week's edition of the Lancet, written by Dr Maria J Wawer, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, and colleagues.

Observational studies have previously reported an association between male circumcision and reduced risk of HIV infection in female partners. In this randomised study, 922 uncircumcised, HIV-infected, asymptomatic men aged 15--49 years with CD4 cell count 350 cells per μl or more were enrolled in the Rakai district of Uganda. Men were then randomised to immediate circumcision (intervention, 474 men) or circumcision after 24 months (control, 448 men). HIV-uninfected female partners of randomised men were also enrolled (intervention 93 women, control 70) and followed up at 6, 12, and 24 months.

The trial was stopped early because of futility. 92 couples in the intervention group and 67 in the control group were included in the final analysis. A higher proportion of women were infected with HIV in the intervention group (18%) versus the control group (12%). Cumulative probability of HIV infection at 24 months was also higher in the intervention group (22%) than in the control group (13%). Although both these findings were not statistically significant, they were sufficient to stop the trial.

The authors conclude: "Circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention."

In an accompanying Comment, Dr Jared M Baeten, University of Washington, Seattle, USA, and colleagues say: "The results of today's study should in no way hinder programmes working to scale up circumcision services for men at risk for HIV. Involvement of women in decision making about circumcision offers an opportunity for enhanced messaging about the risks and benefits of circumcision, for men and for women, and for targeted risk-reduction counselling for HIV-serodiscordant couples."
-end-
Dr Maria J Wawer, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA (currently in Uganda) T) +256-772-200-288 E) mwawer@jhsph.edu

Dr Jared M Baeten, University of Washington, Seattle, USA T) +1 206-543-8897 E) jbaeten@u.washington.edu

For full Article and Comment see: http://press.thelancet.com/circum.pdf

Lancet

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