HIV shedding high following male circumcision; reduced when healed
Viral shedding appears to increase shortly following male circumcision, but drops off as the surgical wound heals, according to recently published data.
“Three trials undertaken in sub-Saharan Africa a decade ago showed that male circumcision … can halve the HIV acquisition rate in men,” the researchers wrote. “With the rollout of voluntary medical male circumcision programs, circumcision has become more normative (regarded as acceptable), and HIV-positive men are increasingly requesting circumcision because they want to avoid any stigma associated with being uncircumcised and because circumcision provides health benefits.”
Researchers examined penile HIV shedding among 223 Ugandan men with HIV before and after circumcision from June 2009 to April 2012. Of these, 183 reported receiving no antiretroviral therapy. HIV serology, plasma viral load and CD4 counts were collected upon enrollment. These measures along with lavage samples were obtained at weekly follow-up visits for 6 weeks, and then at 8 weeks and 12 weeks.
When compared to viral shedding rates before the procedure, the proportion of participants with detected shedding increased 1 week (Prevalence RR [PRR] = 1.87; 95% CI, 1.12-3.14), 2 weeks (PRR = 3.16; 95% CI, 1.94-5.13) and 3 weeks (PRR = 1.98; 95% CI, 1.19-3.28) following circumcision. In contrast, reductions were seen compared to baseline at 6 weeks (PRR = 0.27; 95% CI, 0.09-0.83) and 12 weeks (PRR = 0.19; 95% CI, 0.06-0.64) as the wound began to heal.
Additionally, viral shedding was more likely to occur among participants with a plasma viral load greater than 50,000 copies/ml than those with viral loads fewer than 400 copies/ml (adjusted PRR = 10.3; 95% CI, 4.25-24.9).
“The findings from this study reinforce the need for [male circumcision] programs to provide voluntary HIV counseling and testing prior to [male circumcision], promote sexual abstinence during wound healing and condom use thereafter, offer free condoms, and encourage counseling for HIV-infected men and their sexual partners on the risk of HIV transmission if sexual intercourse is resumed prior to complete wound healing,” the researchers wrote.
Disclosure: Tobian reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.