AEGiS-13IAC: HIV incidence associated with male circumcision in a population-based cohort, and HIV acquisition/transmission associated with circumcision and viral load in discordant couples: Rakai, Uganda.

13th International AIDS Conference

Durban, South Africa - July 9-July 14, 2000

HIV incidence associated with male circumcision in a population-based cohort, and HIV acquisition/transmission associated with circumcision and viral load in discordant couples: Rakai, Uganda.

Int Conf AIDS 2000 Jul 9-14; 13:(abstract no. MoOrC193)

Gray R, Wawer MJ, Sewakambo NK, Serwadda D, Kiwanuka N, Wabwire Mangen F, Li C, Lutalo T, Quinn TC
R. Gray, Johns Hopkins University shcool, 615 n wolfe st. #w 4030, Baltimore md 21 205, United States, Tel.: +1 410 955 78 18, Fax: +1 410 614 73 86, E-mail: rgray@jhsph.edu

BACKGROUND: Male circumcision may reduce HIV acquisition and might provide a means of HIV prevention.

METHODS: HIV acquisition was determined in a representative community cohort of 5,507 HIV-negative Ugandan men. Male HIV acquisition was also assessed in 187 HIV-negative males in discordant relationships with HIV-positive women, and HIV transmission was assessed in 223 HIV-positive males with HIV-negative female partners. HIV incidence per 100 person years (py) and the adjusted rate ratios (RR) and 95% confidence intervals (CI) of HIV seroconversion associated with circumcision 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% for all men; 99.1% in Muslims and 3.7% in non-Muslims. Circumcision was significantly associated with reduced HIV acquisition in the cohort as whole (RR = 0.53, CI 0.33-0.87), but not among non-Muslim men (RR = 0.80, CI 0.33-1.95). Prepubertal circumcision significantly reduced HIV acquisition (RR = 0.49, CI 0.26-0.82), but postpubertal circumcision was not significantly protective (RR = 0.70, CI 0.25-1.55). In discordant couples with HIV-negative male partners, no serconversions occurred in 50 circumcised males, whereas HIV acquisition was 16.7 per 100 py in uncircumcised males (p = 0.004). In couples with HIV-positive males, HIV transmission to the female partner was not significantly reduced if the male was circumcised (RR = 0.44, CI 0.15-1.32), but in couples with male HIV viral loads > 50,000 copies per mL, no transmissions occurred in 22 circumcised males, whereas the transmission rate was 9.6 per 100 py in 143 uncircumcised men (p = 0.02). Interpretation: Prepubertal circumcision may reduce male HIV acquisition in a general population, but the protective effects might be confounded by cultural and behavioral factors. Circumcision markedly reduces HIV acquisition in high risk discordant couples, and reduces HIV transmission by HIV-positive men with viral loads >50,000 copies/mL. The promotion of prepubertal circumcison for HIV prevention is complex and requires careful assessment.

Keywords: AEGIS, Viral Load, Incidence, HIV Infections, HIV Seropositivity, Circumcision, HIV-1, Family Characteristics, Prevalence, Acquired Immunodeficiency Syndrome, Population, Uganda, Human, Male, Female, transmission, epidemiology, surgery
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MoOrC193