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Male circumcision in HIV+ men: effects on HIV viral load
M.J. Wawer1, D. Buwembo2, G. Kigozi2, D. Serwadda2,3, F. Makumbi2,3, F. Nalugoda2, S. Watya4, M. Chen1, B. Iga2, S. Reynolds5,6, R.H. Gray1
1Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 2Rakai Health Sciences Program, Kalisizo, Uganda, 3Makerere University School of Public Health, Kampala, Uganda, 4Makerere University School of Medicine., Kampala, Uganda, 5Johns Hopkins School of Medicine, Baltimore, United States, 6National Institute of Allergy and Infectious Diseases (NIAID)/National Institutes of Health (NIH), Bethesda, United States
Background: As male circumcision (MC) programs expand, some HIV+ men will seek the procedure. We conducted a randomized trial of MC in HIV+ men. Benefits in men included lower rates of male genital ulceration. However, MC did not reduce HIV transmission to women partners. Therefore, we assessed the effects of surgery on postoperative HIV viremia.
Methods: After RCT closure, we collected blood before surgery and weekly for 4 weeks from 88 consenting ART-naïve control arm men with detectable HIV VL who requested MC as a service. HIV VL (log10 copies/ml) was assayed by RT-PCR (Roche Amplicor 1.5). We assessed within person change in VL before and after MC, using paired t tests.
Results: Follow up was >90%. Mean and median VLs were higher in weeks 1-4 after MC (Table 1). The mean within-person difference in HIV VL pre-MC compared to post-surgery was significantly increased at weeks 2-4. However, the absolute increase was modest (mean of 14,125 copies/mL before MC, compared to 22,909 copies/mL at week 4 after MC).
| Visit | N | Median Log10 VL cps/mL | Mean Log10 VL
cps/mL | Mean within person change in Log10 VL | Standard error of difference | P
Value | | Pre-MC | 88 | 4.10 | 4.15 | - | - | - | | Week 1 | 84 | 4.26 | 4.23 | 0.028 | 0.020 | 0.587 | | Week 2 | 88 | 4.35 | 4.25 | 0.140 | 0.051 | 0.007 | | Week 3 | 83 | 4.45 | 4.29 | 0.172 | 0.065 | 0.010 | | Week 4 | 82 | 4.33 | 4.36 | 0.199 | 0.059 | 0.001 |
Conclusions: VL was significantly increased at 2-4 weeks post MC. The stress of surgery may transiently upregulate viremia, but the absolute increase was modest, and is unlikely to explain the lack of MC efficacy in reducing male-to-female HIV transmission. Nonetheless, post-MC safe sex practices, including abstention and condom use, are essential.
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