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


RESULTS
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).


CONCLUSIONS
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.


BACKGROUND
http://www.ClinicalTrials.gov; for HIV-negative men #NCT00425984 and for HIV-positive men, #NCT000124878.
Kigozi
Godfrey
G
Rakai Health Sciences Program, Entebbe, Uganda.
Gray
Ronald H
RH
Wawer
Maria J
MJ
Serwadda
David
D
Makumbi
Frederick
F
Watya
Stephen
S
Nalugoda
Fred
F
Kiwanuka
Noah
N
Moulton
Lawrence H
LH
Chen
Michael Z
MZ
Sewankambo
Nelson K
NK
Wabwire-Mangen
Fred
F
Bacon
Melanie C
MC
Ridzon
Renee
R
Opendi
Pius
P
Sempijja
Victor
V
Settuba
Absolom
A
Buwembo
Denis
D
Kiggundu
Valerian
V
Anyokorit
Margaret
M
Nkale
James
J
Kighoma
Nehemia
N
Charvat
Blake
B
D000293:Adolescent; D000328:Adult; D002944:Circumcision, Male / Q000379:methods / Q000592:standards*; D005500:Follow-Up Studies; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control* / Q000635:transmission; D018023:HIV Seronegativity; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014454:Uganda / Q000453:epidemiology