Circumcision of HIV-infected men: effects on high-risk human papillomavirus infections in a randomized trial in Rakai, Uganda.
In Rakai, Uganda, human immunodeficiency virus (HIV)-positive men were randomized to undergo either immediate circumcision (intervention arm) or delayed circumcision (control arm). Penile swab samples were assayed for high-risk human papillomavirus (HR-HPV) by Roche HPV Linear Array at enrollment and at 24 months (intervention arm, 103 subjects; control arm, 107 subjects). Rate ratios (RRs) of HR-HPV were estimated by Poisson regression. At 24 months, HR-HPV prevalence was found in 57 (55.3%) of 103 subjects in the intervention arm and in 77 (71.7%) of 107 subjects in the control arm (RR, 0.77; 95% confidence interval [CI], 0.62-0.97). Multiple HR-HPV infections were found in 19 (22.4%) of 85 subjects in the intervention arm and in 45 (42.5%) of 106 subjects in the control arm (RR, 0.53; 95% CI, 0.33-0.83). New HR-HPV genotypes were acquired by 34 (42.0%) of 81 subjects in the intervention arm and by 53 (57.0%) 85 subjects in the control arm (RR, 0.74; 95% CI, 0.54-1.01; P = .06). Multiple new HR-HPV genotypes were acquired by 8 (9.9%) of 81 subjects in the intervention arm and by 23 (24.7%) of 93 subjects in the control arm (RR, 0.40; 95% CI, 0.19-0.84; P = .01). Circumcision did not affect the acquisition of single HR-HPV infections (RR, 1.00; 95% CI 0.65-1.53) or clearance of HR-HPV infections (RR, 1.09; 95% CI 0.94-1.27). Circumcision of HIV-positive men reduced the prevalence and incidence of multiple HR-HPV infections.


BACKGROUND
ClinicalTrials.gov identifier: NCT00124878 .
Serwadda
David
D
School of Public Health, Makerere University, Kampala, Uganda.
Wawer
Maria J
MJ
Makumbi
Frederick
F
Kong
Xiangrong
X
Kigozi
Godfrey
G
Gravitt
Patti
P
Watya
Stephen
S
Nalugoda
Fred
F
Ssempijja
Victor
V
Tobian
Aaron A R
AA
Kiwanuka
Noah
N
Moulton
Lawrence H
LH
Sewankambo
Nelson K
NK
Reynolds
Steven J
SJ
Quinn
Thomas C
TC
Oliver
Amy E
AE
Iga
Boaz
B
Laeyendecker
Oliver
O
Gray
Ronald H
RH
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002944:Circumcision, Male; D005838:Genotype; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D015994:Incidence; D008297:Male; D027383:Papillomaviridae / Q000145:classification / Q000235:genetics; D030361:Papillomavirus Infections / Q000150:complications / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D012725:Sexual Behavior; D013997:Time Factors; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult