Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.
Male circumcision for the prevention of HSV-2 and HPV infections and syphilis.
复制标题
DOI：
10.1056/nejmoa0802556
复制
发表时间：
2009-03-26
期刊：
影响因子：
--
通讯作者：
Gray RH
中科院分区：
文献类型：
--
作者：
Tobian AA;Serwadda D;Quinn TC;Kigozi G;Gravitt PE;Laeyendecker O;Charvat B;Ssempijja V;Riedesel M;Oliver AE;Nowak RG;Moulton LH;Chen MZ;Reynolds SJ;Wawer MJ;Gray RH
在三项临床试验中，男性包皮环切术显著降低了人类免疫缺陷病毒（HIV）感染在男性中的发病率。我们评估了男性包皮环切术在hiv阴性青少年男孩和男性中预防单纯疱疹病毒2型（HSV-2）和人乳头瘤病毒（HPV）感染和梅毒的疗效。我们在两项男性包皮环切术预防HIV和其他性传播感染的试验中招募了5534名年龄在15至49岁之间的HIV阴性、未包皮环切术的男性受试者。在这些受试者中，3393人（61.3%）在入组时hsv -2血清阴性。在血清阴性受试者中，随机分配1684人立即行包皮环切术（干预组），1709人在24个月后行包皮环切术（对照组）。在基线、6个月、12个月和24个月时，我们对受试者进行2型单纯疱疹病毒、艾滋病毒感染和梅毒检测，同时进行身体检查和访谈。此外，我们在基线和24个月时评估了一组受试者的HPV感染情况。24个月时，干预组HSV-2血清转化的累积概率为7.8%，对照组为10.3%（干预组校正风险比为0.72；95%可信区间[CI]为0.56 ~ 0.92;P = 0.008）。高危HPV基因型患病率在干预组为18.0%，对照组为27.9%（校正风险比为0.65；95% CI为0.46 ~ 0.90;P = 0.009）。然而，两个研究组在梅毒发病率方面没有观察到显著差异（校正风险比1.10;95% CI, 0.75 ~ 1.65; P = 0.44）。除了降低艾滋病毒感染的发生率外，男性包皮环切术还显著降低了2型单纯疱疹病毒感染的发生率和HPV感染的患病率，这些发现强调了该手术的潜在公共卫生益处。
Male circumcision significantly reduced the incidence of human immunodeficiency virus (HIV) infection among men in three clinical trials. We assessed the efficacy of male circumcision for the prevention of herpes simplex virus type 2 (HSV-2) and human papillomavirus (HPV) infections and syphilis in HIV-negative adolescent boys and men. We enrolled 5534 HIV-negative, uncircumcised male subjects between the ages of 15 and 49 years in two trials of male circumcision for the prevention of HIV and other sexually transmitted infections. Of these subjects, 3393 (61.3%) were HSV-2–seronegative at enrollment. Of the seronegative subjects, 1684 had been randomly assigned to undergo immediate circumcision (intervention group) and 1709 to undergo circumcision after 24 months (control group). At baseline and at 6, 12, and 24 months, we tested subjects for HSV-2 and HIV infection and syphilis, along with performing physical examinations and conducting interviews. In addition, we evaluated a subgroup of subjects for HPV infection at baseline and at 24 months. At 24 months, the cumulative probability of HSV-2 seroconversion was 7.8% in the intervention group and 10.3% in the control group (adjusted hazard ratio in the intervention group, 0.72; 95% confidence interval [CI], 0.56 to 0.92; P = 0.008). The prevalence of high-risk HPV genotypes was 18.0% in the intervention group and 27.9% in the control group (adjusted risk ratio, 0.65; 95% CI, 0.46 to 0.90; P = 0.009). However, no significant difference between the two study groups was observed in the incidence of syphilis (adjusted hazard ratio, 1.10; 95% CI, 0.75 to 1.65; P = 0.44). In addition to decreasing the incidence of HIV infection, male circumcision significantly reduced the incidence of HSV-2 infection and the prevalence of HPV infection, findings that underscore the potential public health benefits of the procedure.