The safety of adult male circumcision in HIV-infected and uninfected men in Rakai, Uganda.
No Thumbnail Available
Date
Journal Title
Journal ISSN
Volume Title
Publisher
Public Library of Science
Abstract
Description
Background
The objective of the study was to compare rates of adverse events (AEs) related to male
circumcision (MC) in HIV-positive and HIV-negative men in order to provide guidance for MC programs that may provide services to HIV-infected and uninfected men.
Methods and Findings A total of 2,326 HIV-negative and 420 HIV-positive men (World Health Organization [WHO] stage I or II and CD4 counts > 350 cells/mm3) were circumcised in two separate but procedurally identical trials of MC for HIV and/or sexually transmitted infection prevention in rural Rakai, Uganda. Participants were followed at 1–2 d and 5–9 d, and at 4–6 wk, to assess surgery-related AEs, wound healing, and resumption of intercourse. AE risks and wound healing were compared in HIV-positive and HIV-negative men. Adjusted odds ratios (AdjORs) were estimated by multiple logistic regression, adjusting for baseline characteristics and postoperative
resumption of sex. At enrollment, HIV-positive men were older, more likely to be
married, reported more sexual partners, less condom use, and higher rates of sexually
transmitted disease symptoms than HIV-negative men. Risks of moderate or severe AEs were 3.1/100 and 3.5/100 in HIV-positive and HIV-negative participants, respectively (AdjOR 0.91, 95% confidence interval [CI] 0.47–1.74). Infections were the most common AEs (2.6/100 in HIV-positive versus 3.0/100 in HIV-negative men). Risks of other complications were similar in the two groups. The proportion with completed healing by 6 wk postsurgery was 92.7% in HIV-positive men and 95.8% in HIV-negative men (p=0.007). AEs were more common in men who resumed intercourse before wound healing compared to those who waited (AdjOR 1.56, 95% CI1.05–2.33).
Conclusions
Overall, the safety of MC was comparable in asymptomatic HIV-positive and HIV-negative men, although healing was somewhat slower among the HIV infected. All men should be strongly counseled to refrain from intercourse until full wound healing is achieved.
The trials were funded by the National Institutes of Health (NIH) (U1AI51171), the Bill & Melinda Gates Foundation (22006.02), and the Fogarty International Center (5D43TW001508 and D43TW00015). This study was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, NIH.
The trials were funded by the National Institutes of Health (NIH) (U1AI51171), the Bill & Melinda Gates Foundation (22006.02), and the Fogarty International Center (5D43TW001508 and D43TW00015). This study was supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, NIH.
Keywords
Male circumcision, HIV/AIDS, Prevention, Rakai District, HIV-positive people, Uganda, CD4 counts