Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: from efficacy to effectiveness to population-level impact.
Incremental role of male circumcision on a generalised HIV epidemic through its protective effect against other sexually transmitted infections: from efficacy to effectiveness to population-level impact.
复制标题
DOI：
10.1136/sti.2008.030346
复制
发表时间：
2008-10
影响因子：
3.6
通讯作者：
Gumel A
中科院分区：
文献类型：
--
作者：
Boily MC;Desai K;Masse B;Gumel A
男性包皮环切术（MC）可以减少艾滋病毒感染。然而，需要更好地了解MC对性传播感染（STI）的间接保护作用。在包皮环切试验中，评估MC在个体水平（无群体免疫效应）和人群水平（有群体免疫效应）对HIV感染的增量获益，因为MC对其他STI具有保护作用。一个动态随机模型的艾滋病毒和性传播感染的肯尼亚人口被用来模拟包皮环切术提供给少数试验参与者或一个大部分的男性，以研究MC对艾滋病毒感染的保护作用，在个人层面和人口层面，分别的影响。在包皮环切术试验（个体水平）的包皮环切术组中，不到20%的HIV感染预防可归因于MC对STI的疗效，而不是MC对HIV的疗效。在人口一级，避孕药具可以大大降低艾滋病毒的流行率，特别是在男性和女性中的长期流行率。然而，即使在人口水平上，由于预防性传播感染，MC对艾滋病毒的长期增量影响也是有限的（即使MC对性传播感染和性传播感染的有效性很高）。在试验中，MC对STI的保护作用对MC对HIV的总体影响不大。还需要开展更多的工作，以确定MC对性传播感染的保护作用是否能对艾滋病毒流行产生显著的增量效益。
Male circumcision(MC) can reduce HIV acquisition. However, a better understanding of the indirect protective effect of MC on sexually transmitted infections (STIs) is required. To assess the incremental benefits conferred by MC on HIV infection at the individual-level in circumcision trials (no herd immunity effect) and at the population-level (with herd immunity effect) due to its protective effect against other STIs. A dynamical stochastic model of HIV and STI infections in a Kenyan population was used to simulate the impact of circumcision offered to a minority of trials participants or to a large fraction of men in order to study the protective role of MC on HIV infection at the individual-level and at the population-level, respectively. Less than 20% of the HIV infections prevented in the circumcised arm of the circumcision trials (individual-level) could be attributable to MC efficacy against STIs rather than MC efficacy against HIV. At the population-level, MC can significantly reduce HIV prevalence especially among males and among females in the longer term. However, even at the population-level, the long-term incremental impact of MC on HIV due to the protection against STI is modest (even if MC efficacy against the STI and STI prevalence was high). The protection of MC against STI contributes little to the overall effect of MC on HIV in the trials. Additional work is needed to identify if the protective effect of MC efficacy against STIs can have a significant incremental benefit on the HIV epidemic.
登录
查看更多内容
影响因子：
3.7
作者：
Nagelkerke, Nico J. D.;Moses, Stephen;Bailey, Robert C.
通讯作者：
Bailey, Robert C.
影响因子：
5
作者：
Leynaert, B;Downs, AM;de Vincenzi, I
通讯作者：
de Vincenzi, I
影响因子：
3.8
作者：
Auvert, B;Buvé, A;Akam, E
通讯作者：
Akam, E
影响因子：
168.9
作者：
LAGA, M;ALARY, M;PIOT, P
通讯作者：
PIOT, P
男性包皮环切术，宗教和传染病：对118个发展中国家的生态分析。
影响因子：
3.7
作者：
Drain, Paul K.;Halperin, Daniel T.;Hughes, James P.;Klausner, Jeffrey D.;Bailey, Robert C.
通讯作者：
Bailey, Robert C.