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
School of Public Health, Fudan University, Shanghai, China.
School of Medicine, University of Washington, Seattle, WA, USA.
AIDS Behav. 2025 Aug 7. doi: 10.1007/s10461-025-04850-4.
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.
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。
