University of Washington, WA, USA.
AIDS. 2010 Mar 13;24(5):737-44. doi: 10.1097/QAD.0b013e32833616e0.
Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision.
DESIGN/METHODS: Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used.
A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07).
Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.
男性割礼可将女性向男性传播 HIV-1 的风险降低约 60%。评估割礼对男性向女性传播 HIV-1 影响的数据存在冲突，一项 HIV-1 血清不一致的夫妇的观察性研究表明传播风险降低，但一项随机试验表明割礼并不能短期获益。
设计/方法：对在非洲 HIV-1 血清不一致的夫妇中进行的前瞻性研究中收集的数据进行了分析，以评估 HIV-1 血清阳性男性的割礼状况与女性伴侣中 HIV-1 获得的风险之间的关系。通过体格检查确定割礼状况。采用 Cox 比例风险分析。
1096 对 HIV-1 血清不一致的夫妇中，男性伴侣感染 HIV-1，中位随访 18 个月；374 名（34%）男性伴侣行割礼。64 名女性伴侣血清转换为 HIV-1（发病率为每 100 人年 3.8 例）。男性伴侣割礼与女性伴侣 HIV-1 感染风险降低约 40%（风险比 0.62，95%置信区间 0.35-1.10，P=0.10）无统计学意义相关。将研究限定为通过病毒测序证实发生在伴侣关系内的 HIV-1 传播事件亚组（n=50）时，这种效应的大小相似（风险比 0.57，P=0.11），调整男性伴侣血浆 HIV-1 浓度后（风险比 0.60，P=0.13），以及排除开始抗逆转录病毒治疗的男性伴侣随访时间后（风险比 0.53，P=0.07）。
在 HIV-1 血清不一致的夫妇中，如果 HIV-1 血清阳性的伴侣为男性，我们观察到割礼并未增加，甚至可能降低了男性向女性传播 HIV-1 的风险。
