Jayathunge Parana H M, McBride William J H, MacLaren David, Kaldor John, Vallely Andrew, Turville Stuart
College of Medicine and Dentistry, James Cook University, Cairns, Queensland, Australia.
The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia.
Open AIDS J. 2014 Sep 30;8:31-44. doi: 10.2174/1874613601408010031. eCollection 2014.
Male circumcision (MC) has been shown to be protective against heterosexual HIV transmission and is being explored in some parts of the world as a means of combating the epidemic. The World Health Organization (WHO) recommends that MC be considered as an important component of HIV prevention in high prevalence settings. We review evidence that demonstrates that the inner foreskin is likely to be the main portal of entry for the HIV virus in males. Whether removal of the inner foreskin accounts for all the protection afforded by circumcision is yet to be established. The proposed mechanisms of protection range from inherent immunohistological factors of foreskin such as difference in thickness of keratin layer and density of target cells for HIV between inner and outer foreskin to physiological mechanisms that follow male circumcision such as drying of secretions underneath foreskin after sexual intercourse, loss of microbiome that attract target cells to the genital mucosa and lack of priming the genital mucosa with less abundant sexual transmitted infections among circumcised men. The aim of this review is to give an updated account on the mechanisms proposed so far on the demonstrated 50-70% protection from HIV transmission through heterosexual intercourse, by male circumcision.
男性包皮环切术已被证明可预防异性间的艾滋病毒传播，目前世界上一些地区正在探索将其作为抗击该流行病的一种手段。世界卫生组织（WHO）建议，在艾滋病毒高流行地区，应将男性包皮环切术视为艾滋病毒预防的重要组成部分。我们回顾了相关证据，这些证据表明，男性的阴茎内包皮很可能是艾滋病毒进入人体的主要入口。切除阴茎内包皮是否能提供包皮环切术所带来的全部保护作用，尚有待确定。所提出的保护机制范围广泛，从包皮固有的免疫组织学因素，如阴茎内、外包皮角质层厚度差异以及艾滋病毒靶细胞密度差异，到男性包皮环切术后的生理机制，如性交后包皮下分泌物变干、吸引靶细胞至生殖器黏膜的微生物群落丧失，以及包皮环切男性中因性传播感染较少而导致的生殖器黏膜未被致敏。本综述的目的是对目前提出的关于男性包皮环切术可使异性性行为传播艾滋病毒的风险降低50%-70%这一已得到证实的保护机制进行更新阐述。
