title: Male circumcision and risk of male-to-female HIV-1 transmission: a multinational prospective study in African HIV-1-serodiscordant couples.
abstract: OBJECTIVE
  Male circumcision reduces female-to-male HIV-1 transmission risk by approximately 60%. Data assessing the effect of circumcision on male-to-female HIV-1 transmission are conflicting, with one observational study among HIV-1-serodiscordant couples showing reduced transmission but a randomized trial suggesting no short-term benefit of circumcision.
  
  
  METHODS
  Data collected as part of a prospective study among African HIV-1-serodiscordant couples were analyzed for the relationship between circumcision status of HIV-1-seropositive men and risk of HIV-1 acquisition among their female partners. Circumcision status was determined by physical examination. Cox proportional hazards analysis was used.
  
  
  RESULTS
  A total of 1096 HIV-1-serodiscordant couples in which the male partner was HIV-1-infected were followed for a median of 18 months; 374 (34%) male partners were circumcised. Sixty-four female partners seroconverted to HIV-1 (incidence 3.8 per 100 person-years). Circumcision of the male partner was associated with a nonstatistically significant approximately 40% lower risk of HIV-1 acquisition by the female partner (hazard ratio 0.62, 95% confidence interval 0.35-1.10, P = 0.10). The magnitude of this effect was similar when restricted to the subset of HIV-1 transmission events confirmed by viral sequencing to have occurred within the partnership (n = 50, hazard ratio 0.57, P = 0.11), after adjustment for male partner plasma HIV-1 concentrations (hazard ratio 0.60, P = 0.13), and when excluding follow-up time for male partners who initiated antiretroviral therapy (hazard ratio 0.53, P = 0.07).
  
  
  CONCLUSIONS
  Among HIV-1-serodiscordant couples in which the HIV-1-seropositive partner was male, we observed no increased risk and potentially decreased risk from circumcision on male-to-female transmission of HIV-1.
authors.affiliation: University of Washington, WA, USA. jbaeten@u.washington.edu
authors.forename: Jared M
authors.initials: JM
authors.lastname: Baeten
authors.forename: Deborah
authors.initials: D
authors.lastname: Donnell
authors.forename: Saidi H
authors.initials: SH
authors.lastname: Kapiga
authors.forename: Allan
authors.initials: A
authors.lastname: Ronald
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
authors.forename: Mubiana
authors.initials: M
authors.lastname: Inambao
authors.forename: Rachel
authors.initials: R
authors.lastname: Manongi
authors.forename: Bellington
authors.initials: B
authors.lastname: Vwalika
authors.forename: Connie
authors.initials: C
authors.lastname: Celum
mesh_terms: D000328:Adult; D044383:Black People; D002944:Circumcision, Male / Q000379:methods*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D018023:HIV Seronegativity; D015497:HIV-1; D015498:HIV-2; D020010:Heterosexuality; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D012725:Sexual Behavior