Article

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

ABSTRACT

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.).

Download full-text

Full-text

Available from: Dirk Taljaard
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: We study an epidemic model that incorporates risk-taking behaviour as a response to a perceived low prevalence of infection that follows from the administration of an effective treatment or vaccine. We assume that knowledge about the number of infected, recovered and vaccinated individuals has an effect in the contact rate between susceptible and infectious individuals. We show that, whenever optimism prevails in the risk behaviour response, the fate of an epidemic may change from disease clearance to disease persistence. Moreover, under certain conditions on the parameters, increasing the efficiency of vaccine and/or treatment has the unwanted effect of increasing the epidemic reproductive number, suggesting a wider range of diseases may become endemic due to risk-taking alone. These results indicate that the manner in which treatment/vaccine effectiveness is advertised can have an important influence on how the epidemic unfolds.
    Preview · Article · Dec 2015 · Journal of Biological Dynamics
  • Source
    • "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). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Empirical estimates of the female-to-male ratio of infections in generalized HIV epidemics in sub-Saharan Africa range from 1.31 in Zambia to 2.21 in Ivory Coast. Inequalities in the gender ratio of infections can arise because of differences in exposure (to HIV-positive partners), susceptibility (given exposure), and survival (once infected). Differences in susceptibility have to date received most attention, but neither the relatively high gender ratio of infections nor the heterogeneity in empirical estimates is fully understood. Objective: Demonstrate the relevance of partnership network attributes and sexual mixing patterns to gender differences in the exposure to HIV-positive partners and the gender ratio of infections. Methods: Agent-based simulation model built in NetLogo. Results: The female-to-male ratio of infections predicted by our model ranges from 1.13 to 1.75. Gender-asymmetric partnership concurrency, rapid partnership turnover, elevated partnership dissolution in female-positive serodiscordant couples, and lower partnership re-entry rates among HIV-positive women can produce (substantial) differences in the gender ratio of infections. Coital dilution and serosorting have modest moderating effects. Conclusions: Partnership network attributes and sexual mixing patterns can have a considerable effect on the gender ratio of HIV infections. We need to look beyond individual behavior and gender differences in biological susceptibility if we are to fully understand, and remedy, gender inequalities in HIV infection in generalized epidemics.
    Full-text · Article · Sep 2015 · Demographic Research
  • Source
    • "One of the major success stories in HIV prevention was of three trials in Kenya, South Africa and Uganda that demonstrated that voluntary medical male circumcision (VMMC) reduced HIV acquisition among heterosexual men by up to 60% (Auvert et al. 2005; Bailey et al. 2007; Grey et al. 2007; Padian et al. 2011). Mathematical modelling indicated that the potential public health benefit of VMMC could significantly reduce HIV prevalence in men, which may also indirectly benefit women (Njeuhmeli et al. 2011; Williams et al. 2006). "
    [Show abstract] [Hide abstract]
    ABSTRACT: While the uptake of voluntary medical male circumcision (VMMC) is increasing, South Africa has only attained 20% of its target to circumcise 80% of adult men by 2015. Understanding the factors influencing uptake is essential to meeting these targets. This qualitative study reports on findings from focus-group discussions with men in rural KwaZulu-Natal, South Africa, about what factors influence their perceptions of VMMC. The study found that VMMC is linked to perceptions of masculinity and male gender identity including sexual health, sexual performance and pleasure, possible risk compensation and self-identity. Findings highlight the need to understand how these perceptions of sexual health and performance affect men's decisions to undergo circumcision and the implications for uptake of VMMC. The study also highlights the need for individualised and contextualised information and counselling that can identify, understand and address the perceptions men have of VMMC, and the impacts they believe it will have on them.
    Full-text · Article · Jan 2015 · Culture Health & Sexuality
Show more