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男男性行为者中的男性包皮环切术与艾滋病毒风险代偿:一项系统评价和荟萃分析。

Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis.

作者信息

Wu Xinsheng, Wang Zhongwen, Shi Yongjian, Fitzpatrick Thomas, Zhang Weijie, Wang Zixin, Mo Phoenix K H, Xie Luyao, Liu Yu, Fernández Vecilla Domingo, Luo Qianqian, Zhang Aidi, Ossa-Giraldo Ana Claudia, Mitchell Kate M, Vermund Sten H, Zou Huachun

机构信息

School of Public Health, Fudan University, Shanghai, China.

School of Medicine, University of Washington, Seattle, WA, USA.

出版信息

AIDS Behav. 2025 Aug 7. doi: 10.1007/s10461-025-04850-4.


DOI:10.1007/s10461-025-04850-4
PMID:40773103
Abstract

Male circumcision (MC) has been shown to reduce the risk of HIV infection among men who have sex with men (MSM) in a recent randomised controlled trial. A question that remains unanswered is whether MC in MSM implies HIV compensation, i.e. condomless sex and/or multiple sex partners. We searched PubMed, Embase, and the Cochrane Library for relevant studies published before November 5, 2024 and reviewed references of included studies. We included interventional and observational studies reporting original quantitative data on the association between MC and condom use or the number of sex partners among MSM. Odds ratios (ORs) and 95% confidence intervals (CIs) were extracted directly from the studies or calculated from available data when necessary. A Mantel-Haenszel random effects model was used to calculate pooled ORs and CIs. The final analysis included 41,694 MSM from 15 eligible studies. No statistically significant association was found between MC and condomless sex (OR 1.02, 95% CI 0.91-1.14; k = 13; I = 18%) or multiple sex partners (OR 1.03, 95% CI 0.94-1.12; k = 10; I = 12%) among MSM. The lack of association persisted in the great majority of subgroup analyses, encompassing country income, age, recruitment setting, time length, year of recruitment, circumcision assessment, proportion circumcised, or risk of bias. In conclusion, MC among MSM was not found to be associated with either condomless sex or multiple sex partners. Nonetheless, standard minimum service packages, as per WHO guidelines, should be integrated and consistently provided within MC programs to better protect MSM from HIV infection.

摘要

在最近一项随机对照试验中,男性包皮环切术(MC)已被证明可降低男男性行为者(MSM)感染艾滋病毒的风险。一个尚未得到解答的问题是,男男性行为者中的包皮环切术是否意味着艾滋病毒补偿,即无保护性行为和/或多个性伴侣。我们在PubMed、Embase和Cochrane图书馆中检索了2024年11月5日前发表的相关研究,并查阅了纳入研究的参考文献。我们纳入了报告男男性行为者中包皮环切术与避孕套使用或性伴侣数量之间关联的原始定量数据的干预性和观察性研究。优势比(OR)和95%置信区间(CI)直接从研究中提取,必要时根据现有数据计算。采用Mantel-Haenszel随机效应模型计算合并OR和CI。最终分析纳入了来自15项符合条件研究的41694名男男性行为者。在男男性行为者中,未发现包皮环切术与无保护性行为(OR 1.02,95% CI 0.91-1.14;k = 13;I = 18%)或多个性伴侣(OR 1.03,95% CI 0.94-1.12;k = 10;I = 12%)之间存在统计学上的显著关联。在绝大多数亚组分析中,这种缺乏关联的情况持续存在,亚组分析涵盖国家收入、年龄、招募地点、时间长度、招募年份、包皮环切术评估、包皮环切比例或偏倚风险。总之,未发现男男性行为者中的包皮环切术与无保护性行为或多个性伴侣有关。尽管如此,应根据世界卫生组织的指南,在包皮环切术项目中整合并持续提供标准最低服务包,以更好地保护男男性行为者免受艾滋病毒感染。

相似文献

[1]
Male Circumcision and HIV Risk Compensation Among Men Who Have Sex with Men: A Systematic Review and Meta-Analysis.

AIDS Behav. 2025-8-7

[2]
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Cochrane Database Syst Rev. 2008-7-16

[3]
Male circumcision for prevention of homosexual acquisition of HIV in men.

Cochrane Database Syst Rev. 2011-6-15

[4]
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[5]
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Syst Rev. 2024-11-26

[6]
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Cochrane Database Syst Rev. 2009-4-15

[7]
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Cochrane Database Syst Rev. 2014

[8]
[Volume and health outcomes: evidence from systematic reviews and from evaluation of Italian hospital data].

Epidemiol Prev. 2013

[9]
HIV prevalence among female sex workers, drug users and men who have sex with men in Brazil: a systematic review and meta-analysis.

BMC Public Health. 2010-6-7

[10]
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Cochrane Database Syst Rev. 2021-4-19

本文引用的文献

[1]
Pharmacokinetics and safety of once-yearly lenacapavir: a phase 1, open-label study.

Lancet. 2025-4-5

[2]
Co-creation and community engagement in implementation research with vulnerable populations: a co-creation process in China.

Sex Health. 2024-12

[3]
Twice-Yearly Lenacapavir for HIV Prevention in Men and Gender-Diverse Persons.

N Engl J Med. 2025-4-3

[4]
Efficacy of Voluntary Medical Male Circumcision to Prevent HIV Infection Among Men Who Have Sex With Men : A Randomized Controlled Trial.

Ann Intern Med. 2024-6

[5]
Equity of PrEP uptake by race, ethnicity, sex and region in the United States in the first decade of PrEP: a population-based analysis.

Lancet Reg Health Am. 2024-4-22

[6]
The prevalence and factors of willingness to accept circumcision among MSM in Maanshan City, China.

AIDS Care. 2024-6

[7]
Using protection motivation theory to explain the intention to initiate human papillomavirus vaccination among men who have sex with men in China.

Tumour Virus Res. 2021-12

[8]
HIV pre-exposure prophylaxis: scaling up for impact now and in the future.

Lancet Public Health. 2021-7

[9]
Association between medical male circumcision and HIV risk compensation among heterosexual men: a systematic review and meta-analysis.

Lancet Glob Health. 2021-7

[10]
Awareness of and Preferences for Preexposure Prophylaxis (PrEP) among MSM at High Risk of HIV Infection in Southern China: Findings from the T2T Study.

Biomed Res Int. 2021

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