Gray R H, Kiwanuka N, Quinn T C, Sewankambo N K, Serwadda D, Mangen F W, Lutalo T, Nalugoda F, Kelly R, Meehan M, Chen M Z, Li C, Wawer M J
Johns Hopkins University, School of Hygiene and Public Health, Department of Population and Family Health Sciences, Baltimore, MD 21205, USA.
AIDS. 2000 Oct 20;14(15):2371-81. doi: 10.1097/00002030-200010200-00019.
Male circumcision is associated with reduced HIV acquisition.
HIV acquisition was determined in a cohort of 5507 HIV-negative Ugandan men, and in 187 HIV-negative men in discordant relationships. Transmission was determined in 223 HIV-positive men with HIV-negative partners. HIV incidence per 100 person years (py) and adjusted rate ratios (RR) and 95% confidence intervals (CI) were estimated by Poisson regression. HIV-1 serum viral load was determined for the seropositive partners in HIV-discordant couples.
The prevalence of circumcision was 16.5% for all men; 99.1% in Muslims and 3.7% in non-Muslims. Circumcision was significantly associated with reduced HIV acquisition in the cohort as a whole (RR 0.53, CI 0.33-0.87), but not among non-Muslim men. Prepubertal circumcision significantly reduced HIV acquisition (RR 0.49, CI 0.26-0.82), but postpubertal circumcision did not. In discordant couples with HIV-negative men, no serconversions occurred in 50 circumcised men, whereas HIV acquisition was 16.7 per 100 py in uncircumcised men (P = 0.004). In couples with HIV-positive men, HIV transmission was significantly reduced in circumcised men with HIV viral loads less than 50000 copies/ml (P = 0.02).
Prepubertal circumcision may reduce male HIV acquisition in a general population, but the protective effects are confounded by cultural and behavioral factors in Muslims. In discordant couples, circumcision reduces HIV acquisition and transmission. The assessment of circumcision for HIV prevention is complex and requires randomized trials.
男性包皮环切术与降低感染艾滋病毒的风险相关。
在一组5507名艾滋病毒阴性的乌干达男性以及187名处于异性伴侣关系中且一方为艾滋病毒阴性的男性中确定艾滋病毒感染情况。在223名艾滋病毒阳性且伴侣为艾滋病毒阴性的男性中确定传播情况。通过泊松回归估计每100人年的艾滋病毒发病率、调整后的率比（RR）和95%置信区间（CI）。对艾滋病毒抗体不一致夫妇中的血清阳性伴侣测定HIV-1血清病毒载量。
所有男性中包皮环切术的患病率为16.5%；穆斯林中为99.1%，非穆斯林中为3.7%。包皮环切术与整个队列中艾滋病毒感染率降低显著相关（RR 0.53，CI 0.33 - 0.87），但在非穆斯林男性中并非如此。青春期前进行包皮环切术可显著降低艾滋病毒感染率（RR 0.49，CI 0.26 - 0.82），但青春期后进行包皮环切术则不然。在艾滋病毒抗体不一致且男性为阴性的夫妇中，50名接受包皮环切术的男性未发生血清转化，而未接受包皮环切术的男性每100人年的艾滋病毒感染率为16.7（P = 0.004）。在男性为艾滋病毒阳性的夫妇中，艾滋病毒载量低于50000拷贝/ml的接受包皮环切术的男性中，艾滋病毒传播显著降低（P = 0.02）。
青春期前进行包皮环切术可能会降低普通人群中男性感染艾滋病毒的风险，但在穆斯林中，保护作用受到文化和行为因素的混淆。在抗体不一致的夫妇中，包皮环切术可降低艾滋病毒感染和传播。对包皮环切术预防艾滋病毒的评估很复杂，需要进行随机试验。
