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Circumcision and HIV transmission

Quinn, Thomas Ca,b

Current Opinion in Infectious Diseases:
doi: 10.1097/QCO.0b013e328012c5bc
HIV infection and AIDS
Abstract

Purpose of review: To review the recent literature on male circumcision and its effect on HIV acquisition.

Recent findings: The report from the randomized clinical trial of male circumcision in South Africa demonstrating a 60% protective effect in preventing HIV acquisition provided the first clinical trial evidence of efficacy of male circumcision in protecting men against HIV infection. This protective effect was consistent with both ecological and epidemiologic studies which also show a protective effect of 50–70% in men at high risk for HIV infection. Biological studies also demonstrate an increased number of HIV receptor cells in the mucosa of foreskin providing additional evidence of HIV susceptibility in the uncircumcised male. Male circumcision may also have a beneficial effect in preventing HIV acquisition in women and lowering selected sexually transmitted infections in both sexes.

Summary: The results of two ongoing randomized clinical trials of male circumcision in Kenya and Uganda are awaited with interest, however male circumcision should be carefully considered as a potential public health tool in preventing HIV acquisition. If other trials confirm the results of the South African trial, implementation of this surgical procedure will need to be carefully scaled up and integrated into other prevention programs with emphasis on surgical training, aseptic techniques, acceptability, availability and cultural considerations.

Author Information

aNational Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA

bThe Johns Hopkins University School of Medicine, Baltimore, Maryland, USA

Correspondence to Thomas C. Quinn, Division of Infectious Diseases, The Johns Hopkins University, 720 Rutland Avenue Ross 1159, Baltimore, MD 21205, USA Tel: +1 410 955 7635; fax: +1 410 614 9775; e-mail: tquinn@jhmi.edu

© 2007 Lippincott Williams & Wilkins, Inc.