Quinn Thomas C
National Institute of Allergy and Infectious Diseases, Bethesda, Maryland, USA.
Curr Opin Infect Dis. 2007 Feb;20(1):33-8. doi: 10.1097/QCO.0b013e328012c5bc.
To review the recent literature on male circumcision and its effect on HIV acquisition.
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.
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.
回顾近期关于男性包皮环切术及其对感染艾滋病毒影响的文献。
南非男性包皮环切术随机临床试验报告显示，在预防感染艾滋病毒方面有60%的保护作用，这为男性包皮环切术保护男性免受艾滋病毒感染的疗效提供了首个临床试验证据。这种保护作用与生态学和流行病学研究一致，这些研究也表明，在艾滋病毒感染高危男性中，保护作用为50%-70%。生物学研究还表明，包皮黏膜中的艾滋病毒受体细胞数量增加，这为未行包皮环切术男性易感染艾滋病毒提供了更多证据。男性包皮环切术在预防女性感染艾滋病毒以及降低两性特定性传播感染方面可能也有有益作用。
人们期待着肯尼亚和乌干达正在进行的两项男性包皮环切术随机临床试验的结果，然而，应认真考虑将男性包皮环切术作为预防感染艾滋病毒的一项潜在公共卫生手段。如果其他试验证实了南非试验的结果，那么就需要谨慎扩大这项外科手术的实施规模，并将其纳入其他预防项目，同时要注重外科培训、无菌技术、可接受性、可及性和文化因素。
