Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples.
Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples.
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DOI：
10.1097/qad.0b013e32833616e0
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发表时间：
2010-03-13
期刊：
影响因子：
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通讯作者：
Partners in Prevention HSV/HIV Transmission Study Team
中科院分区：
文献类型：
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作者：
Baeten JM;Donnell D;Kapiga SH;Ronald A;John-Stewart G;Inambao M;Manongi R;Vwalika B;Celum C;Partners in Prevention HSV/HIV Transmission Study Team
男性包皮环切术将艾滋病毒-1在女性与男性之间传播的风险降低了约60%。评估包皮环切术对艾滋病毒从男性传播到女性的影响的数据相互矛盾，在HIV-1血清不一致的夫妇中进行的一项观察性研究表明，传播减少了，但一项随机试验表明，包皮环切术没有短期好处。作为在非洲艾滋病毒-1血清不一致夫妇中进行的前瞻性研究的一部分，分析了艾滋病毒-1血清阳性男子的包皮环切状况与其女性伴侣感染艾滋病毒-1的风险之间的关系。包皮环切术情况通过体检确定。采用COX比例风险分析。对1096对男性伴侣感染HIV-1的HIV-1血清不一致夫妇进行了平均18个月的随访，其中374对(34%)男性伴侣接受了包皮环切术。64名女性伴侣血清转换为艾滋病毒-1(每100人年发病率3.8)。男性伴侣的包皮环切术与女性伴侣感染∼-1的风险降低40%相关，但没有统计学意义(风险比[HR]0.62，95%可信区间[CI]0.35-1.10，p=0.10)。当仅限于病毒测序证实在伙伴关系内发生的HIV-1传播事件的子集时(n=50，HR 0.57，p=0.11)，在调整男性伴侣血浆HIV-1浓度后(HR 0.60，p=0.13)，以及排除开始抗逆转录病毒治疗的男性伴侣的随访时间(HR 0.53，p=0.07)，这种影响的程度类似。在HIV-1血清阳性伴侣为男性的HIV-1血清不一致夫妇中，我们观察到包皮环切术没有增加艾滋病毒-1从男性传播到女性的风险，而且潜在地降低了风险。
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. 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 non-statistically significant ∼40% lower risk of HIV-1 acquisition by the female partner (hazard ratio [HR] 0.62, 95% confidence interval [CI] 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, HR 0.57, p=0.11), after adjustment for male partner plasma HIV-1 concentrations (HR 0.60, p=0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (HR 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.