Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples
Jared M Baeten, Deborah Donnell, Saidi H Kapiga, Allan Ronald, Grace John-Stewart, Mubiana Inambao, Rachel Manongi, Bellington Vwalika, Connie Celum, Partners in Prevention HSV/HIV Transmission Study Team, Connie Celum, Anna Wald, Jairam Lingappa, Jared Baeten, Mary S Campbell, Robert W Coombs, Lawrence Corey, James P Hughes, Amalia Magaret, M Juliana McElrath, Rhoda Morrow, James I Mullins, William L H Whittington, David Coetzee, Kenneth Fife, Edwin Were, Max Essex, Joseph Makhema, Elly Katabira, Allan Ronald, Susan Allen, Katiyesi Kayitenkore, Etienne Karita, Elizabeth Bukusi, Craig Cohen, Susan Allen, William Kanweka, Susan Allen, Bellington Vwalika, Saidi Kapiga, Rachel Manongi, Carey Farquhar, Grace John-Stewart, James Kiarie, Susan Allen, Sinead Delany-Moretlwe, Helen Rees, Guy de Bruyn, Glenda Gray, James McIntyre, Nelly Rwamba Mugo, Jared M Baeten, Deborah Donnell, Saidi H Kapiga, Allan Ronald, Grace John-Stewart, Mubiana Inambao, Rachel Manongi, Bellington Vwalika, Connie Celum, Partners in Prevention HSV/HIV Transmission Study Team, Connie Celum, Anna Wald, Jairam Lingappa, Jared Baeten, Mary S Campbell, Robert W Coombs, Lawrence Corey, James P Hughes, Amalia Magaret, M Juliana McElrath, Rhoda Morrow, James I Mullins, William L H Whittington, David Coetzee, Kenneth Fife, Edwin Were, Max Essex, Joseph Makhema, Elly Katabira, Allan Ronald, Susan Allen, Katiyesi Kayitenkore, Etienne Karita, Elizabeth Bukusi, Craig Cohen, Susan Allen, William Kanweka, Susan Allen, Bellington Vwalika, Saidi Kapiga, Rachel Manongi, Carey Farquhar, Grace John-Stewart, James Kiarie, Susan Allen, Sinead Delany-Moretlwe, Helen Rees, Guy de Bruyn, Glenda Gray, James McIntyre, Nelly Rwamba Mugo
Abstract
Objective: 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.
Design/methods: 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.
Results: 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).
Conclusion: 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.
Trial registration: ClinicalTrials.gov NCT00194519.
Conflict of interest statement
Conflict of Interest: No authors report conflicts of interest regarding content for this manuscript.
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Source: PubMed