Qian Han-Zhu, Ruan Yuhua, Liu Yu, Milam Douglas F, Spiegel Hans M L, Yin Lu, Li Dongliang, Shepherd Bryan E, Shao Yiming, Vermund Sten H
*Vanderbilt Institute for Global Health, Vanderbilt University School of Medicine, Nashville, TN; †Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN; ‡Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China; §State Key Laboratory for Infectious Disease Prevention and Control, and National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China; ‖Department of Urology, Vanderbilt University School of Medicine, Nashville, TN; ¶HJF-DAIDS, a Division of The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Contractor to National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, MD; #Chaoyang District Center for Disease Control and Prevention, Beijing, China; Departments of **Biostatistics; and ††Pediatrics, Vanderbilt University School of Medicine, Nashville, TN.
J Acquir Immune Defic Syndr. 2016 Apr 1;71(4):444-51. doi: 10.1097/QAI.0000000000000856.
Voluntary medical male circumcision reduces the risk of HIV heterosexual transmission in men, but its effect on male-to-male sexual transmission is uncertain.
Circumcision status of men who have sex with men (MSM) in China was evaluated by genital examination and self-report; anal sexual role was assessed by questionnaire interview. Serostatus for HIV and syphilis was confirmed.
Among 1155 participants (242 were seropositive and 913 with unknown HIV status at enrollment), the circumcision rate by self-report (10.4%) was higher than confirmed by genital examination (8.2%). Male circumcision (by examination) was associated with 47% lower odds of being HIV seropositive [adjusted odds ratio (aOR): 0.53; 95% confidence interval (CI): 0.27 to 1.02] after adjusting for demographic covariates, number of lifetime male sexual partners, and anal sex role. Among MSM who predominantly practiced insertive anal sex, circumcised men had 62% lower odds of HIV infection than those who were uncircumcised (aOR: 0.38; 95% CI: 0.09 to 1.64). Among those whose anal sex position was predominantly receptive or versatile, circumcised men have 46% lower odds of HIV infection than did men who were not circumcised (aOR: 0.54; 95% CI: 0.25 to 1.14). Compared to uncircumcised men reporting versatile or predominantly receptive anal sex positioning, those who were circumcised and reported practicing insertive sex had an 85% lower risk (aOR: 0.15; 95% CI: 0.04 to 0.65). Circumcision was not associated clearly with lower syphilis risk (aOR: 0.91; 95% CI: 0.51 to 1.61).
Circumcised MSM were less likely to have acquired HIV, most pronounced among men predominantly practicing insertive anal intercourse. A clinical trial is needed.
自愿男性包皮环切术可降低男性异性性行为中感染艾滋病毒的风险，但其对男男性行为传播的影响尚不确定。
通过生殖器检查和自我报告评估中国男男性行为者（MSM）的包皮环切状况；通过问卷调查评估肛交角色。确认艾滋病毒和梅毒血清学状态。
在1155名参与者中（242名血清学阳性，913名入组时艾滋病毒状态未知），自我报告的包皮环切率（10.4%）高于生殖器检查确认的比率（8.2%）。在调整人口统计学协变量、终生男性性伴侣数量和肛交角色后，男性包皮环切术（通过检查）与艾滋病毒血清学阳性几率降低47%相关[调整后的优势比（aOR）：0.53；95%置信区间（CI）：0.27至1.02]。在主要进行插入式肛交的男男性行为者中，包皮环切的男性感染艾滋病毒的几率比未包皮环切的男性低62%（aOR：0.38；95%CI：0.09至1.64）。在肛交姿势主要为接受或多变的人群中，包皮环切的男性感染艾滋病毒的几率比未包皮环切的男性低46%（aOR：0.54；95%CI：0.25至1.14）。与报告肛交姿势多变或主要为接受式的未包皮环切男性相比，包皮环切且报告进行插入式性行为的男性风险降低85%（aOR：0.15；95%CI：0.04至0.65）。包皮环切与梅毒风险降低无明显关联（aOR：0.91；95%CI：0.51至1.61）。
包皮环切的男男性行为者感染艾滋病毒的可能性较小，在主要进行插入式肛交的男性中最为明显。需要进行一项临床试验。
