A report in The Lancet today gave the results of a randomised trial conducted in Uganda on 922 uncircumcised, HIV-infected men.
It is already known to protect men from acquiring HIV, but the authors, led by Dr Maria Wawer, state that although long-term effects could not be assessed “circumcision of HIV-infected men did not reduce HIV transmission to female partners over 24 months.”
The report comes after an announcement last month of Bill Gates funding a mass circumcision programme in Swaziland and Zambia, with the goal of curbing HIV.
Observational studies have previously reported on the association between male circumcision and a reduced risk of HIV and other STI transmission to female partners.
Catherine Hankins, chief scientific adviser at the Joint United Nations Programme on HIV/AIDS (UNAIDS) stresses circumcision alone cannot protect men or women against HIV.
The randomised study consisted of men aged 15-49 years enrolled in the Rakai district of Uganda from 2003 to 2007.
Of the 922 men 474 were circumcised (intervention group), with 448 to be circumcised after a 24 month period (control group).
Uninfected female partners of the randomised men were enrolled (intervention 93 women, control 70) and followed up at six, 12, and 24 months.
The trial was halted early due to “futility”. In the final analysis 92 couples from the intervention group and 67 from control were included. It was found that 18% of women from intervention were infected with HIV, a higher proportion than the 12% of the control group.
Cumulative probability of infection at 24 months was also higher in the intervention group at 22% than the 13% of the control group.
Authors state that although these findings were not statistically significant, they were sufficient to stop the trial.
During the study the number of STIs reported by the female partners did not differ between the two groups.
The results have implications on UNAIDS and other circumcision programmes, suggesting that strict adherence to sexual abstinence during wound healing and condom use must be strongly promoted when HIV-infected men receive circumcision.
Dr Wawer said it was not sensible to recommend men with HIV not to be circumcised, or that there should be any down scaling of circumcision programmes, because of the overall benefits to both uninfected men and women. A solution would be to circumcise infants and young boys, stating this would "mitigate the challenge of male circumcision in HIV-infected men."
In an accompanying comment to the Lancet study, Dr Jared M Baeton, University of Washington, USA, said: “The result of today’s study should in no way hinder programmes working to scale up circumcision services for men at risk of HIV.”
The authors conclude: “Condom use after male circumcision is essential for HIV prevention.”