The long-term efficacy of medical male circumcision against HIV acquisition
The long-term efficacy of medical male circumcision against HIV acquisition
复制标题
DOI：
10.1097/01.aids.0000432444.30308.2d
复制
发表时间：
2013-11-28
期刊：
影响因子：
3.8
通讯作者：
Bailey, Robert C.
中科院分区：
文献类型：
--
作者：
Mehta, Supriya D.;Moses, Stephen;Bailey, Robert C.
背景：在三项随机试验中，经过21 - 24个月的随访，医学男性包皮环切术（MMC）使撒哈拉以南非洲异性恋男性的HIV感染率降低了约60%。我们估计72个月的疗效MMC对艾滋病毒的男性中保留的基苏穆随机试验，其中艾滋病毒的收购减少了60%后24 months.Methods：从2002年至2005年，2784名男性年龄在18 - 24岁，随机1：1立即包皮环切术或控制。在2006年12月试验结束时，对照组的男性获得了免费的包皮环切术。后续行动持续到2010年9月。考克斯比例风险回归纳入稳定的治疗和审查通过边际结构模型产生的权重的逆概率，被用来解释潜在的随时间变化的混杂和审查，以估计MMC对HIV risk. Results的疗效：累计72个月的HIV发病率为7.21%[95%置信区间（CI）：5.98 - 8.68%]：4.81%之间包皮环切的男性，11.0%之间未包皮环切的男性。包皮环切术与未包皮环切术男性的HIV血清转化粗风险比为0.38 [95% CI：0.26 - 0.55]。在体重调整后的考克斯回归分析中，风险比为0.42 [95%CI：0.26 - 0.66]。结论：MMC的疗效在72个月时维持在58%，与随机化条件下三项试验的总体结果相似。这些发现提供了包皮环切术对艾滋病毒感染的长期有效性的估计。我们的研究结果支持基于持续有效性假设的方案扩大建议。
Background:In three randomized trials, medical male circumcision (MMC) reduced HIV acquisition in heterosexual men in sub-Saharan Africa by approximately 60%, after 21-24 months of follow-up. We estimated the 72-month efficacy of MMC against HIV among men retained in the Kisumu randomized trial, in which HIV acquisition was reduced by 60% after 24 months.Methods:From 2002 to 2005, 2784 men aged 18-24 were enrolled and randomized 1:1 to immediate circumcision or control. At trial end in December 2006, control men were offered free circumcision. Follow-up continued to September 2010. Cox proportional hazards regression incorporating stabilized inverse probability of treatment and censoring weights generated through marginal structural modeling, was used to account for potential time-varying confounding and censoring to estimate the efficacy of MMC on HIV risk.Results:The cumulative 72-month HIV incidence was 7.21% [95% confidence interval (CI): 5.98-8.68%]: 4.81% among circumcised men, 11.0% among uncircumcised men. The crude hazard ratio of HIV seroconversion for circumcised vs. uncircumcised men was 0.38 [95% CI: 0.26-0.55]. In weight-adjusted Cox regression, the hazard ratio was 0.42 [95% CI: 0.26-0.66].Conclusion:The efficacy of MMC was sustained at 58% at 72 months, similar to overall findings of the three trials under conditions of randomization. These findings provide an estimate of the long-term efficacy of circumcision against HIV acquisition. Our results support programmatic scale-up recommendations that are based on assumptions of sustained efficacy.