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Male circumcision and male-to-female HIV-1 transmission risk: a multinational prospective study
Presented by Jared Baeten (United States).
J. Baeten1, D. Donnell2, M. Inambao3, G. John-Stewart1, S. Kapiga4,5, R. Manongi5, A. Ronald6, B. Vwalika7, C. Celum1, Partners in Prevention HSV/HIV Transmission Study Team
1University of Washington, Seattle, United States, 2Fred Hutchinson Cancer Research Center, Seattle, United States, 3Rwanda Zambia HIV Research Group, Ndola, Zambia, 4London School Hygiene and Tropical Medicine, London, United Kingdom, 5Kilimanjaro Christian Medical Centre, Moshi, Tanzania, United Republic of, 6University of Manitoba, Winnipeg, Canada, 7Rwanda Zambia HIV Research Group, Lusaka, Zambia
Background: Male circumcision reduces female-to-male HIV-1 transmission risk by ~50%. However, few studies have assessed the effect of circumcision on male-to-female HIV-1 transmission. One previous observational study suggested circumcision reduced male-to-female transmission only from men with plasma HIV-1 concentrations < 50,000 copies/mL.
Methods: Data were from a clinical trial of acyclovir HSV-2 suppressive therapy provided to HIV-1/HSV-2 co-infected members of African HIV-1 serodiscordant couples (Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda, Zambia). We evaluated the relationship between circumcision status of HIV-1 seropositive men and risk of HIV-1 acquisition among their female sexual partners. Circumcision status was determined by physical examination at study enrollment. Cox proportional hazards analysis was used.
Results: 1097 HIV-1 serodiscordant couples were enrolled in which the male partner was HIV-1 infected; 374 (34%) male partners were circumcised. Median follow-up was 18 months. 64 female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the HIV-1 infected male partner was associated with a 47% decrease in the risk of HIV-1 acquisition by the female partner (hazard ratio [HR] 0.53, 95% confidence interval [CI] 0.29, 0.99, p=0.046). The magnitude of this effect was similar in analyses adjusting for male partner plasma HIV-1 concentrations (HR 0.56, p=0.06) and unprotected sexual activity (HR 0.52, p=0.03), and when restricted to the subset of HIV-1 transmission events that were confirmed by viral sequencing to have occurred within the partnership (n=49, HR 0.51, p=0.06). The effect of circumcision on male-to-female HIV-1 transmission risk was similar among those with male plasma HIV-1 concentrations >50,000 and ≤50,000 copies/mL. Randomization to acyclovir did not significantly alter the effect of circumcision on male-to-female HIV-1 transmission risk.
Conclusions: In this multinational prospective observational study among HIV-1 serodiscordant couples, female partners of circumcised HIV-1 infected men had decreased HIV-1 risk.
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