United Press International - June 1, 2002
Ed Susman, UPI Science News

The research examined laboratory specimens of healthy human foreskin -- the covering of the penis often removed in an operation, usually soon after birth -- and specimens of cervical tissue from women undergoing surgery. They searched for CD4 T-cells, macrophages and Langerhan's cells, all of which are targets for the human immunodeficiency virus, or HIV -- the virus that causes AIDS.

"We determined that the target cells that HIV infect are found in far greater numbers in the foreskin than in the cervix," said Dr. Carlos Estrada, a urologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Estrada and colleagues presented a paper on their findings at the recent American Urological Association annual meeting in Orlando, Fla.

"Overall, the inner, mucosal surface of the foreskin had a seven-fold greater susceptibility to HIV infection than did cells in cervical tissue infected under the same conditions," Estrada said. The interactions between the cells were studied in culture dishes in the laboratory.

"The issue here is that epidemiologic data strongly suggests that circumcision protects against HIV," said Dr. John Krieger, professor of urology at the University of Washington at Seattle.

"These authors looked at pediatric and adult foreskins (and) ... found ... that foreskins have a lot of HIV target cells. So the increased risk of HIV infection in uncircumcised men is likely caused by large numbers of target cells in the foreskin. (Therefore circumcision) "is biologically plausible as a way to reduce HIV infection risk."

Estrada suggested reduced infection rates in men due to circumcision also should reduce HIV infections in women.

"There has been a lot of controversy over whether circumcision prevents infection with HIV or is simply a marker of more rigorous religious practices," Estrada told UPI.

"We think that our findings may show that the reason populations in Africa where Islam is practiced have lower HIV infections rates than in areas where circumcision is not practiced may be biological rather than faith-based."

Circumcision is routinely performed after birth in the United States and is required for males by Jewish and Muslim religious laws. Several studies have shown in African nations where Islam is predominant, rates of HIV infection can be one-tenth that of nations where circumcision is not practiced or its practice has been abandoned -- as in some of the nations of southern Africa, where AIDS has reached epidemic proportions.

In Nigeria, for example, where circumcision is routinely performed, United Nations AIDS Programme, or UNAIDS, data suggests the HIV infection rate is about 5 percent of adults. In Botswana, however, where circumcision is not widely practiced, the adult HIV infection rate has approached 40 percent.

Researchers and social commenters have been arguing both sides of this issue for some time. For example, at the 2000 World AIDS Conference, held in Durban, South Africa, some speakers argued the difference in rates has nothing to due with circumcision, but everything to do with religious requirements for general cleanliness and monogamy. Other speakers countered that even in heavily Islamic areas, adherence or non-adherence to religious prohibitions against sex outside of marriage parallels behavior in regions dominated by other faiths.

The new cellular research probably will not resolve the question. Dr. Thomas Brady, adjunct professor of urology at the University of Nevada-Reno, and chairman of the media committee of the AUA, said, "I'm not sure that I buy this explanation that more cells in the foreskin increase the risk of transmission of HIV. Just because there are more cells doesn't mean that there is a greater transmission risk."

Brady told UPI, however, he was not discounting the possibility circumcision could inhibit HIV transmission.

"I think it is far more logical to assume that during intercourse the penis suffers microabrasions and microscopic tears," he said.

In uncircumcized men, fluids that come in contact with the penis during intercourse can be trapped under the foreskin, which may make it easier for the virus to infect men through the organ's microscopic openings, Brady suggested.

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