Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples

• Published in: AIDS (London) Vol. 24; no. 5; pp. 737 - 744
• Main Authors: BAETEN, Jared M, DONNELL, Deborah, KAPIGA, Saidi H, RONALD, Allan, JOHN-STEWART, Grace, INAMBAO, Mubiana, MANONGI, Rachel, VWALIKA, Bellington, CELUM, Connie
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 13-03-2010
• Subjects: Acquired immune deficiency syndrome; Adult; African Continental Ancestry Group; AIDS/HIV; Antiretroviral agents; antiretroviral therapy; Biological and medical sciences; Circumcision, Male - methods; Data processing; Disease transmission; Female; Heterosexuality; HIV Infections - epidemiology; HIV Infections - prevention & control; HIV Infections - transmission; HIV Seronegativity; HIV-1; HIV-2; Human immunodeficiency virus 1; Human viral diseases; Humans; Immunodeficiencies; Immunodeficiencies. Immunoglobulinopathies; Immunopathology; Infectious diseases; Male; males; Medical sciences; Prospective Studies; Risk assessment; Risk Factors; Sexual Behavior; Viral diseases; Viral diseases of the lymphoid tissue and the blood. Aids; Africa; Immunopathology; HIV-1 virus; Transmission; HIV-1 discordant couples; Retroviridae; Male; AIDS; male circumcision; Immune deficiency; Lentivirus; Infection; Virus; Viral disease; Risk factor; Female; Human immunodeficiency virus; HIV-1 transmission; Circumcision
• ISSN: 0269-9370; 1473-5571
• DOI: 10.1097/qad.0b013e32833616e0

Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision.
Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used.
A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07).
Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.