Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda

RH Gray, N Kiwanuka, TC Quinn, NK Sewankambo… - Aids, 2000 - journals.lww.com
RH Gray, N Kiwanuka, TC Quinn, NK Sewankambo, D Serwadda, FW Mangen, T Lutalo…
Aids, 2000journals.lww.com
Methods HIV acquisition was determined in a cohort of 5507 HIV-negative Ugandan men,
and in 187 HIV-negative men in discordant relationships. Transmission was determined in
223 HIV-positive men with HIV-negative partners. HIV incidence per 100 person years (py)
and adjusted rate ratios (RR) and 95% confidence intervals (CI) were estimated by Poisson
regression. HIV-1 serum viral load was determined for the seropositive partners in HIV-
discordant couples. Results The prevalence of circumcision was 16.5% for all men; 99.1% in …
Methods
HIV acquisition was determined in a cohort of 5507 HIV-negative Ugandan men, and in 187 HIV-negative men in discordant relationships. Transmission was determined in 223 HIV-positive men with HIV-negative partners. HIV incidence per 100 person years (py) and adjusted rate ratios (RR) and 95% confidence intervals (CI) were estimated by Poisson regression. HIV-1 serum viral load was determined for the seropositive partners in HIV-discordant couples.
Results
The prevalence of circumcision was 16.5% for all men; 99.1% in Muslims and 3.7% in non-Muslims. Circumcision was significantly associated with reduced HIV acquisition in the cohort as a whole (RR 0.53, CI 0.33–0.87), but not among non-Muslim men. Prepubertal circumcision significantly reduced HIV acquisition (RR 0.49, CI 0.26–0.82), but postpubertal circumcision did not. In discordant couples with HIV-negative men, no serconversions occurred in 50 circumcised men, whereas HIV acquisition was 16.7 per 100 py in uncircumcised men (P= 0.004). In couples with HIV-positive men, HIV transmission was significantly reduced in circumcised men with HIV viral loads less than 50 000 copies/ml (P= 0.02).
Lippincott Williams & Wilkins