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Changes in Plasma Viral Load and Penile Viral Shedding After Circumcision Among HIV-Positive Men in Kisumu, Kenya

Odoyo-June, Elijah MBCHB, MSc*,†; Rogers, John H. BS, MPH; Jaoko, Walter MBCHB, PhD*,†; Bailey, Robert C. PhD, MPH*,‡

JAIDS Journal of Acquired Immune Deficiency Syndromes: December 15th, 2013 - Volume 64 - Issue 5 - p 511–517
doi: 10.1097/QAI.0b013e3182a7ef05
Epidemiology and Prevention

Background: We conducted a prospective cohort study of HIV-positive men aged 18–35 years in Kisumu, Kenya to determine if medical circumcision of ART-naive HIV-positive men leads to increased viral load and penile viral shedding.

Methods: From 108 HIV-positive men circumcised by forceps-guided method and followed up weekly for 6 weeks, 29 men were evaluated for penile viral shedding. HIV-1 RNA was measured in plasma from 19 men and in penile lavage samples from 29 men. Samples were collected before circumcision and at weekly intervals for 6 weeks or until the circumcision wound was healed. CD4+ T-cell counts from 102 HIV-positive men were determined at baseline and at 2 weeks thereafter. Wounds with healthy scar, no scab or opening, and no suture tracks were deemed healed.

Results: Among 65 ART-naive men, mean CD4+ T-cell count increased from 417 cells per cubic millimeter at baseline to 456 cells per cubic millimeter after 2 weeks (P = 0.04), but did not change in the 37 men on ART (P = 0.81). There was no change in HIV plasma viral load (P = 0.36), but penile viral shedding rose significantly within 1 week after circumcision then declined to undetectable levels by 6 weeks (multivariate analysis of variance; P < 0.001). In 28 of 29 men (96.6%), there was no detectable viral shedding after certification of wound healing.

Conclusions: Medical circumcision among ART-naive HIV-infected men results in a transitory rise in penile viral shedding before complete wound healing, which should pose no additional risk of HIV transmission if men adhere to 6 weeks postcircumcision sexual abstinence and use condoms consistently.

*Nyanza Reproductive Health Society, Kisumu, Kenya;

University of Nairobi, Nairobi, Kenya; and

Division of Epidemiology and Biostatistics University of Illinois at Chicago, Illinois.

Correspondence to: Elijah Odoyo-June, MBCHB, MSc, Nyanza Reproductive Health Society, P.O. Box 1764, Kisumu 40100, Kenya (e-mail:

Supported by the University of Illinois at Chicago through a grant from the Bill and Melinda Gates Foundation to FHI360. R.C.B. was supported in part by the Chicago Developmental Center for AIDS Research (D-CFAR), an National Institutes of Health (NIH) funded program (P30 AI 082151). Clement Zeh, Julie Okonji, Edith Nyagaya, Lawrence Agunda, and Ruth Murugu provided technical laboratory support for this work.

E.O.J. designed the study, collected data, and performed data analysis, interpretation, and writing. R.C.B designed the study and performed data analysis, interpretation, and writing. J.H.R. designed the study, performed data analysis, interpretation, and writing. W.J. performed analysis, interpretation, critical review, and writing. Clement Zeh, Julie Okonji, Edith Nyagaya, Lawrence Agunda, and Ruth Murugu provided technical laboratory support for this work.

The authors have no conflicts of interest to disclose.

Received April 09, 2013

Accepted July 23, 2013

© 2013 by Lippincott Williams & Wilkins