Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda
Male circumcision and HIV acquisition and transmission: cohort studies in Rakai, Uganda
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DOI：
10.1097/00002030-200010200-00019
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发表时间：
2000-10-20
期刊：
影响因子：
3.8
通讯作者：
Wawer, MJ
中科院分区：
文献类型：
--
作者：
Gray, RH;Kiwanuka, N;Wawer, MJ
工作背景：男性包皮环切术是与减少HIV acquisition.Methods：艾滋病毒收购确定在一个队列中的5507艾滋病毒阴性乌干达男子，并在187艾滋病毒阴性的男性在不一致的关系。在223名艾滋病毒阳性男性与艾滋病毒阴性伴侣中确定了传播。每100人年的HIV发病率（py）和调整后的率比（RR）和95%置信区间（CI）通过泊松回归估计。HIV-1血清病毒载量测定血清学阳性的合作伙伴在HIV-discordantcouples.Results：包皮环切术的患病率为16.5%fbr所有男性，99.1%的穆斯林和3.7%的非穆斯林。在整个队列中，包皮环切术与减少艾滋病毒感染显著相关（RR 0.53，CI 0.33-0.87），但在非穆斯林男性中则不然。青春期前包皮环切术显著降低了HIV感染率（RR 0.49，CI 0.26-0.82），但青春期后包皮环切术则没有。在HIV阴性男性的不一致夫妇中，50名包皮环切术男性未发生血清转化，而未包皮环切术男性的HIV感染率为16.7/100 py（P = 0.004）。在夫妇与HIV阳性的男性，HIV传播显着减少包皮环切术的男性与HIV病毒载量小于50 000拷贝/ml（P = 0.02）。解释：青春期前包皮环切术可能会减少男性艾滋病毒的收购在一般人群中，但穆斯林的文化和行为因素混淆的保护作用。在不和谐的夫妇中，包皮环切减少了艾滋病毒的感染和传播。评估包皮环切术预防艾滋病毒是复杂的，需要随机试验。(C)2000年利平科特威廉姆斯&威尔金斯。
Background: Male circumcision is associated with reduced HIV acquisition.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% fbr 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).Interpretation: Prepubertal circumcision may reduce male HIV acquisition in a general population, but the protective effects are confounded by cultural and behavioral factors in Muslims. In discordant couples, circumcision reduces HIV acquisition and transmission. The assessment of circumcision for HIV prevention is complex and requires randomized trials. (C) 2000 Lippincott Williams & Wilkins.