Navigation Links
PLoS Medicine publishes first trial of effect of male circumcision on HIV infection

The peer-reviewed results of the first trial of the effect of male circumcision on HIV infection, which some experts call "a landmark trial," will be published in PLoS Medicine on October 25. The trial found that circumcision reduced the rate of new infections among heterosexual men in South Africa by about 60%.

Because HIV infection rates are generally lower among African groups where circumcision is a traditional practice, compared with largely non-circumcised populations, researchers had suspected that circumcision might offer some protection against HIV transmission. However, because the lower infection rates in the circumcised groups might be due to some other difference between circumcised and uncircumcised populations, the only way to test whether circumcision has a protective effect is a randomized intervention study. Such trials are under way in Uganda and in Kenya but the trial reported in PLoS Medicine is the first to be completed, peer-reviewed, and published in a medical journal. The large protective effect of male circumcision observed has surprised many HIV experts, and it will be important to see whether the related studies under way confirm the results of this trial.

The trial, conducted by a team of French and South African researchers and sponsored by ANRS (the French National Agency of Research on AIDS), took place in the Orange Farm area near Johannesburg, where male circumcision in adulthood is a common but not universal practice.

The researchers offered young sexually active uncircumcised heterosexual men the chance to be circumcised and then monitored for HIV infection. The participants (3,274 men) were randomly allocated to two different groups--one group was immediately circumcised and the other group was to remain uncircumcised until after the completion of the trial 21 months later. The circumcised men were instructed to abstain from sexual activity for 6 weeks after the operation. The plan was t o follow the participants over 21 months, testing them for HIV at months 3, 12 and 21, to see whether there was a difference in the rate of new infections between the two groups.

After 18 months, the number of new HIV infections in the control group was 49, compared with 20 in the treatment group. The results suggested that circumcision can reduce female-to-male HIV infection by about 60% (95% CI: 32%?6%).

The committee monitoring this study considered that the protective effect of male circumcision was so large that it would be unethical to continue the study. The trial was therefore stopped and the uncircumcised men were offered circumcision.

The trial, results of which were first reported at an international AIDS conference in July, has attracted huge attention among the global health community.

Bertran Auvert and his co-authors have called for the promotion of male circumcision as part of AIDS prevention efforts in Orange Farm and in other parts of Africa. However, other HIV experts take a more cautious view, believing that the results of this one study must be confirmed by further studies before action can be recommended, especially given the relatively small number of new infections (20 among the circumcised men versus 49 among the controls) and the relatively large number of men who did not return for all the follow-up testing (100 and 125, respectively).

In a statement (http://www.who.int/mediacentre/news/releases/2005/pr32/en/) published shortly after Auvert and colleagues' trial was presented at the July conference, UNAIDS emphasized that "although the trial shows promising protective effects of adult male circumcision in HIV acquisition, more research is needed to confirm the reproducibility of the findings and of this trial and whether or not the results have more general application."

Furthermore, adult circumcision carries risks, especially if performed by medical personnel or traditional healers without proper training. Moreover, immediately after circumcision, men may be at a higher risk of acquiring infections (which is why the participants were asked to not to have sex for six weeks after the operation). A further concern is that circumcised men, considering themselves to be "protected," might be more likely to engage in unsafe sex. Research is also needed to find out whether male circumcision only has a preventive effect on female to male transmission, or whether it may also reduce male to female transmission or male to male transmission. In addition, it will be important to determine the mechanism by which circumcision exerts its apparent protective effect.

Three articles published in PLoS Medicine alongside the trial discuss some of these issues further:

  • In an editorial, the PLoS Medicine editors discuss the peer review of the paper and their reasons for publishing it.
  • Peter Cleaton-Jones, chair of the ethics committee that approved the trial, looks at the ethical issues surrounding the trial.
  • Nandi Siegfried, lead author of a recent Cochrane systematic review of male circumcision and HIV, considers the trial's strengths and weaknesses.


'"/>

Source:Public Library of Science


Related biology news :

1. Recent breakthroughs in common adult leukemia highlighted in New England Journal of Medicine
2. Leukemia Drug Breakthrough Study In New England Journal Of Medicine
3. Transport System Smuggles Medicines Into Brain
4. Papers of DNA Pioneer and Nobel Laureate Francis Crick Added to National Library of Medicine’s Profiles in Science Web Site
5. Affymetrix and the Karolinska Institutet Announce Translational Medicine Strategic Alliance
6. FDA Works To Speed The Advent Of New, More Effective Personalized Medicines
7. Genpathway and Baylor College of Medicine Identify New Genes in Breast Cancer
8. Computational Tool Predicts How Drugs Work In Cells, Advancing Efforts To Design Better Medicines
9. $6.5 Million Grant for Microarray Center at Yale School of Medicine
10. Researcher at UGA College of Veterinary Medicine identifies new way of combating viral diseases
11. Smooth sailing: cruise ship virus tackled by UH, Baylor College of Medicine
Post Your Comments:
*Name:
*Comment:
*Email:


(Date:6/9/2016)... , June 9, 2016 ... Police deploy Teleste,s video security solution to ensure the safety ... France during the major tournament Teleste, ... communications systems and services, announced today that its video security ... to back up public safety across the country. ...
(Date:6/2/2016)... 2, 2016   The Weather Company , an IBM ... an industry-first capability in which consumers will be able to ... ask questions via voice or text and receive relevant information ... Marketers have long sought an advertising solution that ... be personal, relevant and valuable; and can scale across millions ...
(Date:5/20/2016)... May 20, 2016  VoiceIt is excited to ... VoicePass. By working together, VoiceIt and ... VoiceIt and VoicePass take slightly different approaches to ... both security and usability. ... this new partnership. "This marketing and ...
Breaking Biology News(10 mins):
(Date:6/27/2016)... PHILADELPHIA , June 27, 2016  Liquid ... today announced the funding of a Sponsored Research ... study circulating tumor cells (CTCs) from cancer patients.  ... changes in CTC levels correlate with clinical outcomes ... therapies. These data will then be employed to ...
(Date:6/24/2016)... , June 24, 2016 Epic Sciences ... detects cancers susceptible to PARP inhibitors by targeting ... cells (CTCs). The new test has already been ... in multiple cancer types. Over 230 ... damage response pathways, including PARP, ATM, ATR, DNA-PK ...
(Date:6/23/2016)... ... June 23, 2016 , ... Mosio, ... second eBook, “Clinical Trials Patient Recruitment and Retention Tips.” Partnering with experienced clinical ... eBook by providing practical tips, tools, and strategies for clinical researchers. , “The ...
(Date:6/23/2016)... June 23, 2016 /PRNewswire/ - FACIT has announced ... biotechnology company, Propellon Therapeutics Inc. ("Propellon" ... commercialization of a portfolio of first-in-class WDR5 inhibitors ... such as WDR5 represent an exciting class of ... precision medicine for cancer patients. Substantial advances have ...
Breaking Biology Technology: