June 4, 2008 Adult circumcision is safe in HIV-infected men without advanced HIV disease, according to research published in PLoS Medicine.
Analyzing results of two clinical trials of circumcision in the rural Rakai district of Uganda, Ron Gray of the Bloomberg School of Public Health, Johns Hopkins University and colleagues found approximately a 3% rate of moderate or severe surgical complications -- primarily infections -- in both HIV-positive and HIV-negative men, when circumcision was performed under optimal conditions. Healing was slower in the HIV-infected men, however, and men who resumed sexual intercourse before complete wound healing were at higher risk of complications. Men with symptoms of HIV infection or low CD4 T-cell counts were not included in the study.
A separately reported analysis from one of these trials found that women partners are more likely to become HIV infected by HIV-positive men who resume sex prior to complete wound healing. Therefore, for protection of both men and their women partners, refraining from intercourse after circumcision is essential until the wound has completely healed, which may take 6 weeks or longer.
Three clinical trials have already shown that circumcision reduces the risk of becoming HIV infected by about 60% in HIV-negative African men, with infrequent side effects. However, the side effects in HIV-positive men have not been previously reported. Because this study found no increased risk of surgical complications in HIV-positive men who undergo circumcision, it should not be necessary to screen men who have no symptoms of HIV in future circumcision programs. Not requiring screening should reduce the complexity of implementing such programs and also reduce any stigma resulting from exclusion, making it likely that more men will be willing to be circumcised.
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- Kigozi et al. The safety of adult male circumcision in HIV-infected and uninfected men in Rakai, Uganda. PLoS Medicine, 2008; 5 (6): e116 DOI: 10.1371/journal.pmed.0050116
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