STUDY:

JOURNAL: IDSA 41st Annual Meeting: Abstract LB-10. Presented 2003.

AUTHORS: Steven J. Reynolds, MD, MPH

ABSTRACT: Results of a prospective cohort study of 2,298 Indian men suggests that circumcision is associated with a "profound 8-fold reduction in HIV-1 risk.

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COMMENTARY: Steven J. Reynolds, MD, MPH, a postdoctoral fellow in infectious diseases at Johns Hopkins University School of Medicine in Baltimore, Maryland, said the study results "not only add to the developing body of knowledge on circumcision and HIV transmission, but they also lend great support to studies now underway Uganda, Kenya, and South Africa."

Compared with uncircumcised men, circumcised men had an adjusted risk of HIV-1 infection of 0.12, which was significant (P = .003). The incidence of HIV-1 infection in uncircumcised men was 5.5%, while it was just 0.7% among the circumcised men.

At an IDSA press conference where the circumcision study was discussed, Cynthia Sears, MD, professor of medicine at Johns Hopkins, said most men in India are not circumcised. "That is also true in parts of sub-Saharan Africa where there are high rates of HIV transmission. In some instances there will be cultural and religious barriers to considering circumcision.

But where it is appropriate, then this is another measure that can help to reduce the rate of transmission," Dr. Sears said. "But [circumcision] does not obviate the need to use condoms," she added. Dr. Sears was not involved in the study.

The important implication in this study is the likelihood that circumcision has some protective efficacy against HIV transmission.