Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health.
J Infect Dis. 2013 Dec 1;208(11):1869-76. doi: 10.1093/infdis/jit371. Epub 2013 Jul 30.
We estimated the 72-month efficacy of medical male circumcision (MMC) against herpes simplex virus 2 (HSV-2) incidence among men in the Kisumu MMC randomized trial.
From 2002 to 2005, 2784 men aged 18-24 were enrolled and randomized 1:1 to immediate circumcision or control. Cox proportional hazards regression incorporating stabilized inverse probability of treatment and censoring weights generated through marginal structural modeling was used to estimate the efficacy of MMC on HSV-2 risk. Conventional conditional Cox regression identified multivariable risks for HSV-2 seroconversion.
Among 2044 HSV-2 seronegative men at baseline, the cumulative 72-month HSV-2 incidence was 33.5% (32.7% among circumcised men, 34.6% among uncircumcised men). In weight-adjusted Cox regression, the hazard ratio was 0.88 (95% confidence interval, .77-1.10). In multivariable analyses, risks for HSV-2 included human immunodeficiency virus (HIV) infection, genital ulcer disease (GUD), penile epithelial trauma, multiple recent sex partners, and being married /cohabiting.
MMC had no effect on acquisition of HSV-2 during 72 months of follow-up. The temporal sequence and limited correlation between HSV-2, GUD, and penile epithelial trauma suggests that these are distinct phenomena rather than misclassification of HSV-2 symptoms. Determining the etiology of non-sexually transmitted infection GUD and penile epithelial trauma is needed, as both are commonly occurring risks for HSV-2 and HIV acquisition.
NCT0005937.
我们评估了医学性包皮环切术（MMC）在 Kisumu MMC 随机试验中对男性单纯疱疹病毒 2（HSV-2）发病率的 72 个月疗效。
2002 年至 2005 年，招募了 2784 名年龄在 18-24 岁的男性，并按 1:1 比例随机分为即刻包皮环切术组或对照组。采用包含稳定逆概率治疗和边缘结构模型生成的校正权重的 Cox 比例风险回归来估计 MMC 对 HSV-2 风险的疗效。传统的条件 Cox 回归确定了 HSV-2 血清转换的多变量风险因素。
在基线时 2044 名 HSV-2 血清阴性的男性中，72 个月的累计 HSV-2 发病率为 33.5%（包皮环切组为 32.7%，未包皮环切组为 34.6%）。在体重校正的 Cox 回归中，风险比为 0.88（95%置信区间，0.77-1.10）。在多变量分析中，HSV-2 的风险因素包括人类免疫缺陷病毒（HIV）感染、生殖器溃疡疾病（GUD）、阴茎上皮创伤、近期多个性伴侣和已婚/同居。
在 72 个月的随访中，MMC 对 HSV-2 的获得没有影响。HSV-2、GUD 和阴茎上皮创伤之间的时间顺序和有限相关性表明，这些是不同的现象，而不是 HSV-2 症状的错误分类。需要确定非性传播感染 GUD 和阴茎上皮创伤的病因，因为这两者都是 HSV-2 和 HIV 获得的常见风险因素。
NCT0005937。
