title: Circumcision of HIV-infected men: effects on high-risk human papillomavirus infections in a randomized trial in Rakai, Uganda.
abstract: 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 .
authors.affiliation: School of Public Health, Makerere University, Kampala, Uganda.
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: Frederick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Xiangrong
authors.initials: X
authors.lastname: Kong
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: Patti
authors.initials: P
authors.lastname: Gravitt
authors.forename: Stephen
authors.initials: S
authors.lastname: Watya
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Victor
authors.initials: V
authors.lastname: Ssempijja
authors.forename: Aaron A R
authors.initials: AA
authors.lastname: Tobian
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Moulton
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Amy E
authors.initials: AE
authors.lastname: Oliver
authors.forename: Boaz
authors.initials: B
authors.lastname: Iga
authors.forename: Oliver
authors.initials: O
authors.lastname: Laeyendecker
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
mesh_terms: 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