United Press International - July 27, 2005
Ed Susman

The result: "We demonstrated that we could reduce HIV infection by 65 percent through male circumcision in this group of individuals," Dr. Bertran Auvert, professor of public health at the University of Versailles, France, told United Press International. "This is the first randomized, controlled trial demonstrating a strong protective effect of safe male circumcision on HIV acquisition by males."

The study was performed in the Johannesburg, South Africa, suburb of Orange Farm, a poverty-stricken community that has no farms, nor any orange trees, but has a 32 percent prevalence of infection with the human immunodeficiency virus, the agent that causes AIDS.

All the men agreed to circumcision before they were assigned either to surgery -- under local anesthesia by physicians -- or waiting through the course of the trial for 21 months before having the penile foreskin removed.

The men were seen by researchers three months after surgery or inclusion into the trial and then again at 12 months and 21 months. The study began in 2002 and ended prematurely in 2005 because the Data Monitoring Safety Board detected far more HIV infections in the uncircumcised men.

The study results, presented at the 3rd International AIDS Society Conference on HIV Pathogenesis and Treatment, were greeted with caution.

Finding the results "exciting," Dr. Helene Gayle, president of the International AIDS Society, also advised caution before advocating voluntary circumcision on the part of young men.

"This could be a major advance in prevention," Gayle said at a news briefing on the study, "however, we need to see the results of other trials to confirm these findings. Adult male circumcision should not be implemented as a preventive strategy until other trials are done."

Auvert acknowledged that his study is not a green light for circumcision, noting the area where it was performed is somewhat unique in its population and HIV infection prevalence. For example, the men were engaging in heterosexual activities and the study was performed only for 21 months, so how long the protective effect continues is unknown.

He also said the treatment may be effective only in preventing female-to-male transmission of HIV and may not prevent male-to-male transmission or male-to-female transmission

"The treatment was not 100 percent successful, so safe sex is still important in preventing transmission of HIV," Auvert said.

About 20 percent of men in the area undergo voluntary circumcision, he said, so the proposal was not a foreign idea. During the scheduled visits to the doctors during the trial the sexually active men were counseled regarding safe sex activities.

Nevertheless, 69 infections occurred during the trial among the men, all of whom were HIV-negative at its start. Of those infections, 58 occurred in the uncircumcised men and 18 in those who had undergone the operation. That translates into a 65 percent reduction, Auvert said.

The major adverse side effect mentioned by those undergoing the surgery was pain. No one died in the study from the surgery, and no permanent injuries occurred among men undergoing the surgery.

"Another way of putting it," he said, "is that we prevented six or seven out of a possible 10 infections" by circumcising the men.

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Edward Susman covers medical research and health matters for UPI Science News. E-mail: sciencemail@upi.com
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