Randomized, Controlled Intervention Trial of Male Circumcision for Reduction of HIV Infection Risk: The ANRS 1265 Trial

Hôpital Ambroise-Paré, Assitance Publique-Hôpitaux de Paris, Boulogne, France.
PLoS Medicine (Impact Factor: 14.43). 12/2005; 2(11):e298. DOI: 10.1371/journal.pmed.0020298
Source: PubMed


Observational studies suggest that male circumcision may provide protection against HIV-1 infection. A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis.
A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21. Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up. The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models. Rate ratios (RR) of HIV incidence were determined with 95% CI. Protection against HIV infection was calculated as 1 - RR. The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.0-21.0) when the data were analyzed. There were 20 HIV infections (incidence rate = 0.85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.24%-0.68%; p < 0.001). This RR corresponds to a protection of 60% (95% CI: 32%-76%). When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%-77%).
Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved. Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa. (Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Rio de Janeiro, Brazil.).

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    • "This approach would add to the current knowledge as much of the available literature is derived from participants in clinical trials where conditions likely do not match real-world settings. As such, other avenues of future research would be to analyse the problems of partial protection and inadequate adherence to medical regimens when examining biomedical forms of HIV prevention (see also[1,5,15,24]). Finally, another point of interest for us, especially in light of the emergence of drug resistant infections, is to study mathematically whether the evolution towards resistant strains is significantly influenced by behavioural changes in the exposed population. "
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    • "7 Women's greater susceptibility is attributed to a number of biological mechanisms, including differences in genital immunology that are well described in the literature (Chersich and Rees 2008; Higgins, Hoffman, and Dworkin 2010; Yi et al. 2013). A variety of co-factors may alter susceptibility to HIV infection, including the presence of both viral and bacterial sexually transmitted infections (STI) (Cohen 2004; Glynn et al. 2001; Hertog 2008; UNAIDS/WHO 2000) 8 and male circumcision (Auvert et al. 2005; Hertog 2008). The contributions of pregnancy (Gray et al. 2005; Marston et al. 2013; Morrison et al. 2007) and hormonal contraceptives to women's disproportionally high infection rates are less certain (WHO 2012). "
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