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EFFECT OF CIRCUMCISION OF HIV SERONEGATIVES ON HPV TRANSMISSION TO SERONEGATIVE WOMEN IN UGANDA

Tuesday, 14th of June 2011

 ‘Our findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing the prevalence and incidence of HPV infections in female partners. However, protection is only partial; the promotion of safe sex practices is also important.’

 Best viewed in full at http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61967-8/fulltext

 

outline goes here

The Lancet, Volume 377, Issue 9761, Pages 209 - 218, 15 January 2011

Published Online: 07 January 2011

Effect of circumcision of HIV-negative men on transmission of human papillomavirus to HIV-negative women: a randomised trial in Rakai, Uganda

Original Text

Prof Maria J Wawer MD a f †, Dr Aaron AR Tobian MD a c † , Godfrey Kigozi MBChB f, Xiangrong Kong PhD a d, Patti E Gravitt PhD e, David Serwadda MMed f g, Fred Nalugoda MHS f g, Frederick Makumbi PhD f g, Victor Ssempiija ScM f, Nelson Sewankambo MMed f h, Stephen Watya MMed i, Kevin P Eaton BS b, Amy E. Oliver BA b, Michael Z Chen MSc a, Steven J Reynolds MD b j, Prof Thomas C Quinn MD b j, Prof Ronald H Gray MD a f

Background

Randomised trials show that male circumcision reduces the prevalence and incidence of high-risk human papillomavirus (HPV) infection in men. We assessed the efficacy of male circumcision to reduce prevalence and incidence of high-risk HPV in female partners of circumcised men.

Methods

In two parallel but independent randomised controlled trials of male circumcision, we enrolled HIV-negative men and their female partners between 2003 and 2006, in Rakai, Uganda. With a computer-generated random number sequence in blocks of 20, men were assigned to undergo circumcision immediately (intervention) or after 24 months (control). HIV-uninfected female partners (648 of men from the intervention group, and 597 of men in the control group) were simultaneously enrolled and provided interview information and self-collected vaginal swabs at baseline, 12 months, and 24 months. Vaginal swabs were tested for high-risk HPV by Roche HPV Linear Array. Female HPV infection was a secondary endpoint of the trials, assessed as the prevalence of high-risk HPV infection 24 months after intervention and the incidence of new infections during the trial. Analysis was by intention-to-treat. An as-treated analysis was also done to account for study-group crossovers. The trials were registered, numbers NCT00425984 and NCT00124878.

Findings

During the trial, 18 men in the control group underwent circumcision elsewhere, and 31 in the intervention group did not undergo circumcision. At 24-month follow-up, data were available for 544 women in the intervention group and 488 in the control group; 151 (27·8%) women in the intervention group and 189 (38·7%) in the control group had high-risk HPV infection (prevalence risk ratio=0·72, 95% CI 0·60—0·85, p=0·001). During the trial, incidence of high-risk HPV infection in women was lower in the intervention group than in the control group (20·7 infections vs 26·9 infections per 100 person-years; incidence rate ratio=0·77, 0·63—0·93, p=0·008).

Interpretation

Our findings indicate that male circumcision should now be accepted as an efficacious intervention for reducing the prevalence and incidence of HPV infections in female partners. However, protection is only partial; the promotion of safe sex practices is also important.

Funding

The Bill & Melinda Gates Foundation, National Institutes of Health, and Fogarty International Center.

a Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA

b Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA

c Department of Pathology, Johns Hopkins University, Baltimore, MD, USA

d Department of Biostatistics, Johns Hopkins University, Baltimore, MD, USA

e Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA

f Rakai Health Sciences Program, Entebbe, Uganda

g School of Public Health, Makerere University, Kampala, Uganda

h School of Allied Medical Sciences and Department of Medicine, Makerere University, Kampala, Uganda

i Department of Urology, Makerere University, Kampala, Uganda

j Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA

Correspondence to: Dr Aaron Tobian, Department of Pathology, Johns Hopkins University, Carnegie 667, 600 N Wolfe St, Baltimore, MD 21287, USA

† Joint first authors.