Circumcision Halves Risk of Heterosexual HIV Transmission

Two studies of men in sub-Saharan Africa were halted early when interim analyses of results confirmed that circumcision can significantly reduce heterosexual transmission of the human immunodeficiency virus (HIV).

The trials, both sponsored by the U.S. National Institute of Allergy and Infectious Diseases (NIAID, Bethesda, MD, USA), were originally scheduled to continue until mid-2007, but the significant benefit identified in the preliminary analyses prompted the NIAID to stop the studies on the basis of the clear clinical benefit of circumcision. A trial of 2,784 HIV-negative men in Kisumu (Kenya) found a 53% reduction in HIV acquisition in circumcised versus non-circumcised men. In the second trial, a study of 4,996 HIV-negative men in Rakai (Uganda), circumcision was associated with a 48% reduction in HIV infection.

Both trials involved adult, HIV-negative heterosexual male volunteers assigned at random to either intervention (circumcision performed by trained medical professionals in a clinic setting) or no intervention (no circumcision). All participants were extensively counseled in HIV prevention and risk-reduction techniques. The interim results of the adult male circumcision clinical trials and notification of their discontinuation was released by the NIAID in December 2006.

"Many studies have suggested that male circumcision plays a role in protecting against HIV acquisition,” said Anthony S. Fauci, M.D., director, NIAID. "We now have confirmation from large, carefully controlled, randomized clinical trials showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse. While the initial benefit will be fewer HIV infections in men, ultimately adult male circumcision could lead to fewer infections in women in those areas of the world where HIV is spread primarily through heterosexual intercourse.”

In sub-Saharan Africa, HIV is usually spread by heterosexual intercourse and most men are not circumcised. Observational studies had suggested that HIV prevalence closely tracked circumcision practices in countries where circumcision was common, while in countries where circumcision was uncommon, HIV prevalence was higher.



Related Links:
National Institute of Allergy and Infectious Diseases