肯尼亚基苏木 HIV 阳性男性行包皮环切术后血浆病毒载量和阴茎病毒脱落的变化。
Changes in plasma viral load and penile viral shedding after circumcision among HIV-positive men in Kisumu, Kenya.
机构信息
*Nyanza Reproductive Health Society, Kisumu, Kenya; †University of Nairobi, Nairobi, Kenya; and ‡Division of Epidemiology and Biostatistics University of Illinois at Chicago, Illinois.
出版信息
J Acquir Immune Defic Syndr. 2013 Dec 15;64(5):511-7. doi: 10.1097/QAI.0b013e3182a7ef05.
BACKGROUND
We conducted a prospective cohort study of HIV-positive men aged 18-35 years in Kisumu, Kenya to determine if medical circumcision of ART-naive HIV-positive men leads to increased viral load and penile viral shedding.
METHODS
From 108 HIV-positive men circumcised by forceps-guided method and followed up weekly for 6 weeks, 29 men were evaluated for penile viral shedding. HIV-1 RNA was measured in plasma from 19 men and in penile lavage samples from 29 men. Samples were collected before circumcision and at weekly intervals for 6 weeks or until the circumcision wound was healed. CD4 T-cell counts from 102 HIV-positive men were determined at baseline and at 2 weeks thereafter. Wounds with healthy scar, no scab or opening, and no suture tracks were deemed healed.
RESULTS
Among 65 ART-naive men, mean CD4 T-cell count increased from 417 cells per cubic millimeter at baseline to 456 cells per cubic millimeter after 2 weeks (P = 0.04), but did not change in the 37 men on ART (P = 0.81). There was no change in HIV plasma viral load (P = 0.36), but penile viral shedding rose significantly within 1 week after circumcision then declined to undetectable levels by 6 weeks (multivariate analysis of variance; P < 0.001). In 28 of 29 men (96.6%), there was no detectable viral shedding after certification of wound healing.
CONCLUSIONS
Medical circumcision among ART-naive HIV-infected men results in a transitory rise in penile viral shedding before complete wound healing, which should pose no additional risk of HIV transmission if men adhere to 6 weeks postcircumcision sexual abstinence and use condoms consistently.
背景
我们在肯尼亚基苏木进行了一项针对 18-35 岁艾滋病毒阳性男性的前瞻性队列研究，以确定对接受抗逆转录病毒治疗（ART）的艾滋病毒阳性男性进行医学性包皮环切术是否会导致病毒载量增加和阴茎病毒脱落。
方法
从 108 名通过夹心法接受包皮环切术并在接下来的 6 周内每周进行随访的艾滋病毒阳性男性中，有 29 名男性评估了阴茎病毒脱落情况。从 19 名男性的血浆中测量了 HIV-1 RNA，并从 29 名男性的阴茎冲洗样本中测量了 HIV-1 RNA。在包皮环切术前和 6 周内的每周间隔采集样本，直到包皮环切术伤口愈合。在 102 名艾滋病毒阳性男性中，在基线和此后 2 周时测定了 CD4 T 细胞计数。有健康瘢痕、无结痂或开口、无缝线痕迹的伤口被认为已愈合。
结果
在 65 名未接受 ART 的男性中，平均 CD4 T 细胞计数从基线时的 417 个细胞/立方毫米增加到 2 周后的 456 个细胞/立方毫米（P=0.04），但在接受 ART 的 37 名男性中没有变化（P=0.81）。HIV 血浆病毒载量没有变化（P=0.36），但在包皮环切术后 1 周内，阴茎病毒脱落显著增加，然后在 6 周时降至无法检测的水平（方差分析的多变量分析；P<0.001）。在 29 名男性中的 28 名（96.6%）中，在伤口愈合得到确认后，没有检测到病毒脱落。
结论
在未接受 ART 的 HIV 感染男性中进行医学性包皮环切术会导致阴茎病毒脱落短暂增加，在伤口完全愈合之前，如果男性遵守包皮环切术后 6 周的性禁欲并始终使用安全套，这不应增加 HIV 传播的风险。
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