男男性行为人群中的环切术状况和 HIV 感染：一项 III 期 HIV 疫苗临床试验的再分析。

Circumcision status and HIV infection among MSM: reanalysis of a Phase III HIV vaccine clinical trial.

机构信息

HIV Vaccine and Special Studies Team, Epidemiology Branch, Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.

出版信息

AIDS. 2010 May 15;24(8):1135-43. doi: 10.1097/QAD.0b013e328337b8bd.

DOI:10.1097/QAD.0b013e328337b8bd

PMID:20168206

Abstract

OBJECTIVE

Determine whether male circumcision would be effective in reducing HIV transmission among men who have sex with men (MSM).

DESIGN

Retrospective analysis of the VAXGen VAX004 HIV vaccine clinical trial data.

METHODS

Survival analysis was used to associate time to HIV infection with multiple predictors. Unprotected insertive and receptive anal sex predictors were highly correlated, thus separate models were run.

RESULTS

Four thousand eight hundred and eighty-nine participants were included in this reanalysis; 86.1% were circumcised. Three hundred and forty-two (7.0%) men became infected during the study; 87.4% were circumcised. Controlling for demographic characteristics and risk behaviors, in the model that included unprotected insertive anal sex, being uncircumcised was not associated with incident HIV infection [adjusted hazards ratio (AHR) = 0.97, confidence interval (CI) = 0.56-1.68]. Furthermore, while having unprotected insertive (AHR = 2.25, CI = 1.72-2.93) or receptive (AHR = 3.45, CI = 2.58-4.61) anal sex with an HIV-positive partner were associated with HIV infection, the associations between HIV incidence and the interaction between being uncircumcised and reporting unprotected insertive (AHR = 1.78, CI = 0.90-3.53) or receptive (AHR = 1.26, CI = 0.62-2.57) anal sex with an HIV-positive partner were not statistically significant. Of the study visits when a participant reported unprotected insertive anal sex with an HIV-positive partner, HIV infection among circumcised men was reported in 3.16% of the visits (80/2532) and among uncircumcised men in 3.93% of the visits (14/356) [relative risk (RR) = 0.80, CI = 0.46-1.39].

CONCLUSIONS

Among men who reported unprotected insertive anal sex with HIV-positive partners, being uncircumcised did not confer a statistically significant increase in HIV infection risk. Additional studies with more incident HIV infections or that include a larger proportion of uncircumcised men may provide a more definitive result.

摘要

目的

确定男性包皮环切术是否能有效降低男男性行为者（MSM）中的 HIV 传播。

设计

对 VAXGen VAX004 HIV 疫苗临床试验数据进行回顾性分析。

方法

使用生存分析将 HIV 感染时间与多个预测因子相关联。未受保护的插入性和接受性肛交预测因子高度相关，因此分别运行了模型。

结果

本重新分析纳入了 4889 名参与者；86.1%的参与者接受了包皮环切术。342 名（7.0%）男性在研究期间感染了 HIV；87.4%的参与者接受了包皮环切术。在控制人口统计学特征和风险行为后，在包含未受保护的插入性肛交的模型中，未接受包皮环切术与 HIV 感染无关[校正后的危险比（AHR）=0.97，置信区间（CI）=0.56-1.68]。此外，虽然与 HIV 阳性伴侣进行未受保护的插入性（AHR=2.25，CI=1.72-2.93）或接受性（AHR=3.45，CI=2.58-4.61）肛交与 HIV 感染相关，但未接受包皮环切术与报告未受保护的插入性（AHR=1.78，CI=0.90-3.53）或接受性（AHR=1.26，CI=0.62-2.57）与 HIV 阳性伴侣进行肛交之间的 HIV 发病率之间的关联无统计学意义。在参与者报告与 HIV 阳性伴侣进行未受保护的插入性肛交的研究访问中，报告接受包皮环切术的男性中 HIV 感染发生在 3.16%的访问中（80/2532），而未接受包皮环切术的男性中 HIV 感染发生在 3.93%的访问中（14/356）[相对风险（RR）=0.80，CI=0.46-1.39]。