PLoS Medicine (Jun 2008)

The safety of adult male circumcision in HIV-infected and uninfected men in Rakai, Uganda.

  • Godfrey Kigozi,
  • Ronald H Gray,
  • Maria J Wawer,
  • David Serwadda,
  • Frederick Makumbi,
  • Stephen Watya,
  • Fred Nalugoda,
  • Noah Kiwanuka,
  • Lawrence H Moulton,
  • Michael Z Chen,
  • Nelson K Sewankambo,
  • Fred Wabwire-Mangen,
  • Melanie C Bacon,
  • Renee Ridzon,
  • Pius Opendi,
  • Victor Sempijja,
  • Absolom Settuba,
  • Denis Buwembo,
  • Valerian Kiggundu,
  • Margaret Anyokorit,
  • James Nkale,
  • Nehemia Kighoma,
  • Blake Charvat

DOI
https://doi.org/10.1371/journal.pmed.0050116
Journal volume & issue
Vol. 5, no. 6
p. e116

Abstract

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The objective of the study was to compare rates of adverse events (AEs) related to male circumcision (MC) in HIV-positive and HIV-negative men in order to provide guidance for MC programs that may provide services to HIV-infected and uninfected men.A total of 2,326 HIV-negative and 420 HIV-positive men (World Health Organization [WHO] stage I or II and CD4 counts > 350 cells/mm3) were circumcised in two separate but procedurally identical trials of MC for HIV and/or sexually transmitted infection prevention in rural Rakai, Uganda. Participants were followed at 1-2 d and 5-9 d, and at 4-6 wk, to assess surgery-related AEs, wound healing, and resumption of intercourse. AE risks and wound healing were compared in HIV-positive and HIV-negative men. Adjusted odds ratios (AdjORs) were estimated by multiple logistic regression, adjusting for baseline characteristics and postoperative resumption of sex. At enrollment, HIV-positive men were older, more likely to be married, reported more sexual partners, less condom use, and higher rates of sexually transmitted disease symptoms than HIV-negative men. Risks of moderate or severe AEs were 3.1/100 and 3.5/100 in HIV-positive and HIV-negative participants, respectively (AdjOR 0.91, 95% confidence interval [CI] 0.47-1.74). Infections were the most common AEs (2.6/100 in HIV-positive versus 3.0/100 in HIV-negative men). Risks of other complications were similar in the two groups. The proportion with completed healing by 6 wk postsurgery was 92.7% in HIV-positive men and 95.8% in HIV-negative men (p = 0.007). AEs were more common in men who resumed intercourse before wound healing compared to those who waited (AdjOR 1.56, 95% CI 1.05-2.33).Overall, the safety of MC was comparable in asymptomatic HIV-positive and HIV-negative men, although healing was somewhat slower among the HIV infected. All men should be strongly counseled to refrain from intercourse until full wound healing is achieved.http://www.ClinicalTrials.gov; for HIV-negative men #NCT00425984 and for HIV-positive men, #NCT000124878.