OBJECTIVE: We assessed the protective effect of medical male circumcision (MMC) against HIV, herpes simplex virus type 2 (HSV-2), and genital ulcer disease (GUD) incidence. DESIGN:Two thousand, seven hundred and eighty-seven men aged 18-24 years living in Kisumu, Kenya were randomly assigned to circumcision (n=1391) or delayed circumcision (n=1393) and assessed by HIV and HSV-2 testing and medical examinations during follow-ups at 1, 3, 6, 12, 18, and 24 months. METHODS: Cox regression estimated the risk ratio of each outcome (incident HIV, GUD, HSV-2) for circumcision status and multivariable models estimated HIV risk associated with HSV-2, GUD, and circumcision status as time-varying covariates. RESULTS:HIV incidence was 1.42 per 100 person-years. Circumcision was 62% protective against HIV [risk ratio=0.38; 95% confidence interval (CI) 0.22-0.67] and did not change when controlling for HSV-2 and GUD (risk ratio=0.39; 95% CI 0.23-0.69). GUD incidence was halved among circumcised men (risk ratio=0.52; 95% CI 0.37-0.73). HSV-2 incidence did not differ by circumcision status (risk ratio=0.94; 95% CI 0.70-1.25). In the multivariable model, HIV seroconversions were tripled (risk ratio=3.44; 95% CI 1.52-7.80) among men with incident HSV-2 and seven times greater (risk ratio=6.98; 95% CI 3.50-13.9) for men with GUD. CONCLUSION: Contrary to findings from the South African and Ugandan trials, the protective effect of MMC against HIV was independent of GUD and HSV-2, and MMC had no effect on HSV-2 incidence. Determining the causes of GUD is necessary to reduce associated HIV risk and to understand how circumcision confers protection against GUD and HIV.
RCT Entities:
OBJECTIVE: We assessed the protective effect of medical male circumcision (MMC) against HIV, herpes simplex virus type 2 (HSV-2), and genital ulcer disease (GUD) incidence. DESIGN: Two thousand, seven hundred and eighty-seven men aged 18-24 years living in Kisumu, Kenya were randomly assigned to circumcision (n=1391) or delayed circumcision (n=1393) and assessed by HIV and HSV-2 testing and medical examinations during follow-ups at 1, 3, 6, 12, 18, and 24 months. METHODS: Cox regression estimated the risk ratio of each outcome (incident HIV, GUD, HSV-2) for circumcision status and multivariable models estimated HIV risk associated with HSV-2, GUD, and circumcision status as time-varying covariates. RESULTS: HIV incidence was 1.42 per 100 person-years. Circumcision was 62% protective against HIV [risk ratio=0.38; 95% confidence interval (CI) 0.22-0.67] and did not change when controlling for HSV-2 and GUD (risk ratio=0.39; 95% CI 0.23-0.69). GUD incidence was halved among circumcised men (risk ratio=0.52; 95% CI 0.37-0.73). HSV-2 incidence did not differ by circumcision status (risk ratio=0.94; 95% CI 0.70-1.25). In the multivariable model, HIV seroconversions were tripled (risk ratio=3.44; 95% CI 1.52-7.80) among men with incident HSV-2 and seven times greater (risk ratio=6.98; 95% CI 3.50-13.9) for men with GUD. CONCLUSION: Contrary to findings from the South African and Ugandan trials, the protective effect of MMC against HIV was independent of GUD and HSV-2, and MMC had no effect on HSV-2 incidence. Determining the causes of GUD is necessary to reduce associated HIV risk and to understand how circumcision confers protection against GUD and HIV.
Authors: Ronald H Gray; Godfrey Kigozi; David Serwadda; Frederick Makumbi; Stephen Watya; Fred Nalugoda; Noah Kiwanuka; Lawrence H Moulton; Mohammad A Chaudhary; Michael Z Chen; Nelson K Sewankambo; Fred Wabwire-Mangen; Melanie C Bacon; Carolyn F M Williams; Pius Opendi; Steven J Reynolds; Oliver Laeyendecker; Thomas C Quinn; Maria J Wawer Journal: Lancet Date: 2007-02-24 Impact factor: 79.321
Authors: J S Smith; R C Bailey; D J Westreich; I Maclean; K Agot; J O Ndinya-Achola; W Hogrefe; R A Morrow; S Moses Journal: Sex Transm Infect Date: 2008-10-27 Impact factor: 3.519
Authors: A E Brankin; A A R Tobian; O Laeyendecker; T R Suntoke; A Kizza; B Mpoza; G Kigozi; F Nalugoda; B Iga; M Z Chen; R H Gray; M J Wawer; T C Quinn; S J Reynolds Journal: Int J STD AIDS Date: 2009-09 Impact factor: 1.359
Authors: Aaron A R Tobian; David Serwadda; Thomas C Quinn; Godfrey Kigozi; Patti E Gravitt; Oliver Laeyendecker; Blake Charvat; Victor Ssempijja; Melissa Riedesel; Amy E Oliver; Rebecca G Nowak; Lawrence H Moulton; Michael Z Chen; Steven J Reynolds; Maria J Wawer; Ronald H Gray Journal: N Engl J Med Date: 2009-03-26 Impact factor: 91.245
Authors: Emilie Hope-Rapp; Vassili Anyfantakis; Sebastien Fouéré; Philippe Bonhomme; Jean B Louison; Thibault Tandeau de Marsac; Benedicte Chaine; Pascale Vallee; Isabelle Casin; Catherine Scieux; François Lassau; Michel Janier Journal: Sex Transm Dis Date: 2010-03 Impact factor: 2.830
Authors: Ronald H Gray; David Serwadda; Aaron A R Tobian; Michael Z Chen; Frederick Makumbi; Tara Suntoke; Godfrey Kigozi; Fred Nalugoda; Boaz Iga; Thomas C Quinn; Lawrence H Moulton; Oliver Laeyendecker; Steven J Reynolds; Xiangrong Kong; Maria J Wawer Journal: PLoS Med Date: 2009-11-24 Impact factor: 11.069
Authors: Jason Bailey Reed; Emmanuel Njeuhmeli; Anne Goldzier Thomas; Melanie C Bacon; Robert Bailey; Peter Cherutich; Kelly Curran; Kim Dickson; Tim Farley; Catherine Hankins; Karin Hatzold; Jessica Justman; Zebedee Mwandi; Luke Nkinsi; Renee Ridzon; Caroline Ryan; Naomi Bock Journal: J Acquir Immune Defic Syndr Date: 2012-08-15 Impact factor: 3.731
Authors: Supriya D Mehta; Stephen Moses; Kawango Agot; Ian Maclean; Elijah Odoyo-June; Hong Li; Robert C Bailey Journal: J Infect Dis Date: 2013-07-30 Impact factor: 5.226
Authors: Aaron A R Tobian; Godfrey Kigozi; Maria J Wawer; David Serwadda; Thomas C Quinn; Ronald H Gray Journal: AIDS Date: 2013-01-02 Impact factor: 4.177
Authors: Rachel T Esra; Abraham J Olivier; Jo-Ann S Passmore; Heather B Jaspan; Rushil Harryparsad; Clive M Gray Journal: Front Immunol Date: 2016-06-24 Impact factor: 7.561