Mills E, Cooper C, Anema A, Guyatt G
St Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada.
HIV Med. 2008 Jul;9(6):332-5. doi: 10.1111/j.1468-1293.2008.00596.x.
Observational studies and a small collection of randomized controlled trials (RCTs) suggest that male circumcision may significantly reduce HIV transmission between sero-discordant contacts. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization have recently announced recommendations to scale up male circumcision in countries with generalized epidemics and low levels of male circumcision. However, no meta-analysis has been conducted to determine the effectiveness of this intervention.
We conducted a systematic review of medical literature, and included any RCTs assessing male circumcision to prevent heterosexually acquired HIV infection among males. We used the DerSimonian-Laird random effects method to pool study outcomes. We calculated the relative risk (RR), risk difference, number needed to treat (NNT) and I(2), all with 95% confidence intervals (CIs).
We identified three RCTs that met our inclusion criteria, involving a total of 11 050 men. The pooled RR was 0.44 (95% CI 0.33-0.60, P<0.0001, I(2)=0%, 95% CI 0-35%). The risk difference was 0.014 (95% CI 0.07-0.21), yielding a NNT of 72 (95% CI 50-143).
Male circumcision is an effective strategy for reducing new male HIV infections. Its impact on a population level will require consistently safe sexual practices to maintain the protective benefit.
观察性研究及少量随机对照试验表明，男性包皮环切术可能显著降低血清学不一致性伴侣间的HIV传播。联合国艾滋病规划署（UNAIDS）和世界卫生组织最近宣布了相关建议，在艾滋病广泛流行且男性包皮环切率较低的国家扩大男性包皮环切术。然而，尚未进行荟萃分析以确定该干预措施的有效性。
我们对医学文献进行了系统综述，纳入了所有评估男性包皮环切术预防男性异性性传播HIV感染的随机对照试验。我们使用DerSimonian-Laird随机效应方法汇总研究结果。我们计算了相对风险（RR）、风险差值、需治疗人数（NNT）和I²，均带有95%置信区间（CI）。
我们确定了三项符合纳入标准的随机对照试验，共涉及11050名男性。汇总后的RR为0.44（95%CI 0.33 - 0.60，P<0.0001，I² = 0%，95%CI 0 - 35%）。风险差值为0.014（95%CI 0.07 - 0.21），得出需治疗人数为72（95%CI 50 - 143）。
男性包皮环切术是减少男性新发HIV感染的有效策略。其对人群水平的影响将需要持续的安全性行为来维持保护效益。
