Saturday, 24 October 2009

Male circumcision and risk of HIV infection in women

The protective effect of circumcision against female-to-male transmission of HIV has received a lot of attention, but also relevant is the effect on male-to-female transmission.

A few months ago, Wawer et al. published results of an RCT showing that the male's circumcision status had no effect on male to female transmission of HIV. Now, Weiss et al. have published a meta-analysis of studies addressing this aspect. Their meta-analysis includes Wawer's study (I assume; I haven't read the full text, but am unaware of any other RCTs) as well as six observational studies. They report:
A random-effects meta-analysis of data from the one randomised controlled trial and six longitudinal analyses showed little evidence that male circumcision directly reduces risk of HIV in women (summary relative risk 0.80, 95% CI 0.53-1.36).
This news will no doubt be disappointing for many, as there were hints that circumcision might protect against multiple transmission routes, but the evidence suggests otherwise. As Weiss et al. note, further RCTs - needed to settle the question - are unlikely to occur.

Still, we must not forget the indirect benefit to women: reducing the risk of a male acquiring HIV in turn reduces the probability that he will pass it on to a partner.

1 comment:

Richard said...

If we can trust studies by biased researchers...

Her name "Weiss" gives her motives away. Amazing how many pro-circ people are Jewish.

Traditional circumcision is most probably the cause of the HIV epidemic in Africa. Circumcision done in a medical setting is preferable to tradisional. No circ would be most beneficial.

These pro-circ HIV researchers also do not accept that a lot of the HIV epidemic is not sexual based. Contaminated needles, blood transfusions and mother to child transmission are all likely to be what is sustaining the epidemic. The risk of transmission is 1 in 2000 for a man who has vaginal intercourse with a woman. That rate is not enough to sustain an epidemic.

These sexual health researchers want the epidemic to be purely sexual because that is how they get more research grants. Note that on some of the studies they suggest "more studies need to be done to investigate further" the link - most recently, as one of your previous blogs highlighted, that HPV may increase the risk of HIV transmission.

What would decrease the risk is condoms. And yet a lot of Africans don't have access to them. Even if circ did decrease the risk it would be counter-intuitive - Why would anyone get circed if they were going to wear condoms anyway? Although condoms aren't 100% effective, with the low rate of transmission, they are definitely sufficient to stop an epidemic.