Moses S, Plummer F A, Bradley J E, Ndinya-Achola J O, Nagelkerke N J, Ronald A R
Department of Community Health, University of Nairobi, Kenya.
Sex Transm Dis. 1994 Jul-Aug;21(4):201-10. doi: 10.1097/00007435-199407000-00004.
Whether male circumcision reduces the risk of acquiring human immunodeficiency virus (HIV) infection remains controversial.
As there have now been a number of studies conducted that have examined this issue, we undertook to review their findings. Thirty epidemiological studies identified in the literature that investigated the association between male circumcision status and risk for HIV infection were reviewed.
Eighteen cross-sectional studies from six countries reported a statistically significant association, four studies from four countries found a trend toward an association. Four studies from two countries found no association. Two prospective studies reported significant associations, as did two ecological studies. In studies in which significant associations were demonstrated, measures of increased risk ranged from 1.5 to 8.4. The groups in which positive associations were found included sexually transmitted disease (STD) clinic and hospital patients, outpatient clinic and HIV screening clinic attenders, long-distance truck drivers, and general community members.
Potential sources of error, assessment of causality, implications of the findings, and future research needs are discussed. Because a substantial body of evidence links noncircumcision in men with risk for HIV infection, consideration should be given to male circumcision as an intervention to reduce HIV transmission.
男性包皮环切术是否能降低感染人类免疫缺陷病毒（HIV）的风险仍存在争议。
由于目前已经开展了多项研究来探讨这个问题，我们着手对这些研究结果进行综述。对文献中确定的30项调查男性包皮环切术状态与HIV感染风险之间关联的流行病学研究进行了综述。
来自6个国家的18项横断面研究报告了具有统计学意义的关联，来自4个国家的4项研究发现存在关联趋势。来自2个国家的4项研究未发现关联。2项前瞻性研究和2项生态学研究报告了显著关联。在证明存在显著关联的研究中，风险增加的幅度为1.5至8.4。发现存在正相关的人群包括性传播疾病（STD）诊所和医院的患者、门诊诊所和HIV筛查诊所的就诊者、长途卡车司机以及普通社区成员。
讨论了潜在的误差来源、因果关系评估、研究结果的意义以及未来的研究需求。由于大量证据表明男性未进行包皮环切术与HIV感染风险相关，应考虑将男性包皮环切术作为一种减少HIV传播的干预措施。
