Mehta Supriya D, Moses Stephen, Agot Kawango, Odoyo-June Elijah, Li Hong, Maclean Ian, Hedeker Donald, Bailey Robert C
aDivision of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois, USA bDepartments of Medical Microbiology, Community Health Sciences and Medicine, University of Manitoba, Winnipeg, Canada cImpact Research & Development Organization, Kisumu, Kenya dDepartment of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada.
AIDS. 2013 Nov 28;27(18):2899-907. doi: 10.1097/01.aids.0000432444.30308.2d.
In three randomized trials, medical male circumcision (MMC) reduced HIV acquisition in heterosexual men in sub-Saharan Africa by approximately 60%, after 21-24 months of follow-up. We estimated the 72-month efficacy of MMC against HIV among men retained in the Kisumu randomized trial, in which HIV acquisition was reduced by 60% after 24 months.
From 2002 to 2005, 2784 men aged 18-24 were enrolled and randomized 1 : 1 to immediate circumcision or control. At trial end in December 2006, control men were offered free circumcision. Follow-up continued to September 2010. Cox proportional hazards regression incorporating stabilized inverse probability of treatment and censoring weights generated through marginal structural modeling, was used to account for potential time-varying confounding and censoring to estimate the efficacy of MMC on HIV risk.
The cumulative 72-month HIV incidence was 7.21% [95% confidence interval (CI): 5.98-8.68%]: 4.81% among circumcised men, 11.0% among uncircumcised men. The crude hazard ratio of HIV seroconversion for circumcised vs. uncircumcised men was 0.38 [95% CI: 0.26-0.55]. In weight-adjusted Cox regression, the hazard ratio was 0.42 [95% CI: 0.26-0.66].
The efficacy of MMC was sustained at 58% at 72 months, similar to overall findings of the three trials under conditions of randomization. These findings provide an estimate of the long-term efficacy of circumcision against HIV acquisition. Our results support programmatic scale-up recommendations that are based on assumptions of sustained efficacy.
在三项随机试验中，经过21 - 24个月的随访，医学男性包皮环切术（MMC）使撒哈拉以南非洲异性恋男性感染艾滋病毒的几率降低了约60%。我们估计了基苏木随机试验中留存男性接受MMC后72个月预防艾滋病毒的效果，该试验中24个月后艾滋病毒感染率降低了60%。
2002年至2005年，招募了2784名年龄在18 - 24岁的男性，并按1∶1随机分为立即包皮环切组或对照组。在2006年12月试验结束时，为对照组男性提供免费包皮环切术。随访持续到2010年9月。采用Cox比例风险回归分析，结合通过边际结构模型生成的稳定化治疗逆概率和删失权重，以考虑潜在的随时间变化的混杂因素和删失情况，从而估计MMC对艾滋病毒感染风险的效果。
72个月累积艾滋病毒发病率为7.21%[95%置信区间（CI）：5.98 - 8.68%]：包皮环切男性为4.81%，未包皮环切男性为11.0%。包皮环切男性与未包皮环切男性艾滋病毒血清转化的粗风险比为0.38[95%CI：0.26 - 0.55]。在权重调整的Cox回归分析中，风险比为0.42[95%CI：0.26 - 0.66]。
MMC在72个月时的效果维持在58%，与三项试验在随机分组条件下的总体结果相似。这些发现提供了包皮环切术预防艾滋病毒感染的长期效果估计。我们的结果支持基于持续效果假设的扩大项目规模的建议。
