Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa
Effect of Male Circumcision on the Prevalence of High-Risk Human Papillomavirus in Young Men: Results of a Randomized Controlled Trial Conducted in Orange Farm, South Africa
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DOI：
10.1086/595566
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发表时间：
2009-01-01
影响因子：
6.4
通讯作者：
Taljaard, Dirk
中科院分区：
文献类型：
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作者：
Auvert, Bertran;Sobngwi-Tambekou, Joelle;Taljaard, Dirk
背景高危型人乳头瘤病毒（HR-HPV）与宫颈癌之间存在因果关系，宫颈癌是一个主要的公共卫生问题。本研究的目的是探讨男性包皮环切术（MC）与年轻男性HR-HPV感染率之间的关系。我们使用了在南非橙子农场进行的MC试验的数据，该试验在18-24岁的男性中进行。在连续262天的时间内，从报告计划随访访视的干预组（包皮环切术）和对照组（未包皮环切术）受试者中采集尿道拭子样本。使用聚合酶链反应分析拭子样本。采用单因素和多因素对数Poisson回归分析HR-HPV患病率比（PRRs）。在意向治疗分析中，干预组和对照组的HR-HPV患病率分别为14.8%（94/637）和22.3%（140/627），PRR为0.66（0.51-0.86）（P = 0.002）。控制倾向评分和混杂因素（种族、年龄、教育、性行为[包括安全套使用]、婚姻状况和人类免疫缺陷病毒状态）对结果没有影响。这是第一个随机对照试验显示MC后尿道HR-HPV感染的患病率降低。这一发现解释了为什么女性与割礼的合作伙伴是在宫颈癌的风险低于其他妇女。
Background. A causal association links high-risk human papillomavirus (HR-HPV) and cervical cancer, which is a major public health problem. The objective of the present study was to investigate the association between male circumcision ( MC) and the prevalence of HR-HPV among young men.Methods. We used data from a MC trial conducted in Orange Farm, South Africa, among men aged 18-24 years. Urethral swab samples were collected during a period of 262 consecutive days from participants in the intervention (circumcised) and control (uncircumcised) groups who were reporting for a scheduled follow-up visit. Swab samples were analyzed using polymerase chain reaction. HR-HPV prevalence rate ratios (PRRs) were assessed using univariate and multivariate log Poisson regression.Results. In an intention-to-treat analysis, the prevalences of HR-HPV among the intervention and control groups were 14.8% (94/637) and 22.3% (140/627), respectively, with a PRR of 0.66 (0.51-0.86) (P =.002). Controlling for propensity score and confounders (ethnic group, age, education, sexual behavior [including condom use], marital status, and human immunodeficiency virus status) had no effect on the results.Conclusions. This is the first randomized controlled trial to show a reduction in the prevalence of urethral HR-HPV infection after MC. This finding explains why women with circumcised partners are at a lower risk of cervical cancer than other women.