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Does sex in the early period after circumcision increase HIV-seroconversion risk? Pooled analysis of adult male circumcision clinical trials

Mehta, Supriya Da; Gray, Ronald Hb; Auvert, Bertranc; Moses, Stephend; Kigozi, Godfreye; Taljaard, Dirkf; Puren, Adrieng; Agot, Kawangoh; Serwadda, Davidi; Parker, Corette Bj; Wawer, Maria Jb; Bailey, Robert Ca

doi: 10.1097/QAD.0b013e32832afe95
Epidemiology and social

Objective: To evaluate whether sexual intercourse soon after adult male circumcision affected HIV risk.

Design: Combined analysis of data from African trials of men who were randomized to and underwent circumcision.

Methods: We examined two associations: early sex (intercourse <42 days after circumcision) and HIV acquisition at 3 months for the Orange Farm and Kisumu trials and at 6 months for the Rakai and Kisumu trials and incomplete wound healing at 1 month and seroconversion at 3 and 6 months for the Kisumu trial and at 6 months for the Rakai trial.

Results: Early sex was reported by 3.9% of participants in Kisumu, 5.4% in Rakai, and 22.5% in Orange Farm. HIV seroprevalence was 0.0% at 3 months and 1.9% at 6 months among 18–24-year-olds reporting early sex and 0.2% at 3 months and 0.6% at 6 months among those who did not report early sex. In pooled analyses, men reporting early sex did not have higher HIV infection risk at 3 or 6 months. In Kisumu, 16 (1.3%) men had incomplete wound healing at the 30-day visit. One (6.3%) of these seroconverted at 3 months compared with 2 (0.2%) of 1246 men with complete wound healing (P = 0.075). No association was observed between incomplete wound healing and seroconversion for Rakai participants.

Conclusion: Most men delayed intercourse after circumcision. Early sex after circumcision was not associated with HIV risk, although the study power was limited. Nevertheless, men should delay intercourse to limit the potential for increased HIV risk until complete wound healing.

aDivision of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA

bBloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA

cFaculté de Médecine, University of Versailles, Saint Maurice, France

dDepartments of Medical Microbiology, Community Health Sciences and Medicine, University of Manitoba, Winnipeg, Canada

eRakai Health Sciences Program, Entebbe, Uganda

fProgressus, Johannesburg, South Africa

gVirology, National Institute for Communicable Disease, Sandringham, South Africa

hUNIM Project, Kisumu, Kenya

iSchool of Public Health, Makerere University, Kampala, Uganda

jRTI International, Research Triangle Park, North Carolina, USA.

Received 20 October, 2008

Revised 15 February, 2009

Accepted 27 February, 2009

Correspondence to Dr Supriya D. Mehta, 958 SPHPI M/C 923; 1603 W. Taylor St.; Chicago, IL 60612, USA. Tel: +1 312 413 7485; fax: +1 312 996 0064; e-mail: supriyad@uic.edu

© 2009 Lippincott Williams & Wilkins, Inc.