Circumcision could be a preventive measure against HIV infection

Friday, 3 April 2009- Safe male circumcision should be provided for HIV high-risk population, was the conclusion of a report presented by Prof. J. N. Krieger of University of Washington from Seattle, USA at the 24th Annual EAU Congress last month.

In his introduction, Prof. Krieger touched upon the history of circumcision, with its roots going back to Ancient Egypt, as well as the current status of this procedure. He emphasised that the issue still raises much controversy, and indicated that more research is needed to investigate medical benefits of circumcision or lack of thereof for different groups of population.

He also gave a brief overview of the current HIV statistics in the world, mentioning that there is a strong association of circumcision with a four-fold reduction in the risk of HIV infection. Following up on the statement, Prof. Krieger cited several studies, which supported the beneficial effect of this procedure if used as a preventive measure.

Specifically, he singled out a small study conducted in Uganda by Quinn et al, which observed the preventive effect of circumcision in local discordant couples. Such couples, where an HIV negative man is married to an HIV positive woman, are becoming increasingly common due to a combination of two factors : the fact that many men today die of HIV-related causes, and the tradition, which dictates that the brother of a deceased man takes the responsibility of looking after the widow by marrying her.

Prof. Krieger cited the results of this study which revealed that out of 137 previously HIV negative uncircumcised men, 40 seroconverted within the observed period. Among the HIV negative men who had been circumcised prior to the study (50 in total) nobody seroconverted within the observed period.

Prof. Krieger emphasised the need to evaluate the role of circumcision for men who are at a high risk for HIV infection. He then quoted the results of a study by Weiss at al. saying that “overall, circumcised men are at half the risk of HIV, and this number is certainly something that we must carefully think about.”

He then reported on the study conducted by his own group in Kisumu, Kenia, where HIV prevalence in 20-26% in adult men, with 90% of male population uncircumcised. Data suggested that between age 18 and 25, HIV prevalence increases from 5 to 25%.

The objective of the study was to develop a standard procedure for male circumcision in a resource-poor medical setting and prospectively evaluate the outcome in a randomised, controlled trial with the incidence of HIV as the main outcome.

Healthy, uncircumcised, HIV-seronegative men aged 18–24 years from Kisumu District, Kenya, were offered participation in a clinical trial using a standard circumcision procedure based on 'usual' medical procedures in Western Kenya. The follow-up included visits at 3, 8 and 30 days after circumcision, with additional visits if necessary. Healing, satisfaction and resumption of activities were assessed at these visits and 3 months from randomisation.

The results of the study suggested that circumcision can be performed safely in the conditions available in the areas with high prevalence of HIV, employing techniques practiced by local surgeons. This, according to Dr. Kriger, is a solid argument to advocate for male circumcision to be used as a public-health measure in high-risk developing countries.

By Evgenia Starkova

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