Changes in plasma viral load and penile viral shedding after circumcision among HIV-positive men in Kisumu, Kenya.
BACKGROUND
We conducted a prospective cohort study of HIV-positive men aged 18-35 years in Kisumu, Kenya to determine if medical circumcision of ART-naive HIV-positive men leads to increased viral load and penile viral shedding.


METHODS
From 108 HIV-positive men circumcised by forceps-guided method and followed up weekly for 6 weeks, 29 men were evaluated for penile viral shedding. HIV-1 RNA was measured in plasma from 19 men and in penile lavage samples from 29 men. Samples were collected before circumcision and at weekly intervals for 6 weeks or until the circumcision wound was healed. CD4 T-cell counts from 102 HIV-positive men were determined at baseline and at 2 weeks thereafter. Wounds with healthy scar, no scab or opening, and no suture tracks were deemed healed.


RESULTS
Among 65 ART-naive men, mean CD4 T-cell count increased from 417 cells per cubic millimeter at baseline to 456 cells per cubic millimeter after 2 weeks (P = 0.04), but did not change in the 37 men on ART (P = 0.81). There was no change in HIV plasma viral load (P = 0.36), but penile viral shedding rose significantly within 1 week after circumcision then declined to undetectable levels by 6 weeks (multivariate analysis of variance; P < 0.001). In 28 of 29 men (96.6%), there was no detectable viral shedding after certification of wound healing.


CONCLUSIONS
Medical circumcision among ART-naive HIV-infected men results in a transitory rise in penile viral shedding before complete wound healing, which should pose no additional risk of HIV transmission if men adhere to 6 weeks postcircumcision sexual abstinence and use condoms consistently.
*Nyanza Reproductive Health Society, Kisumu, Kenya; †University of Nairobi, Nairobi, Kenya; and ‡Division of Epidemiology and Biostatistics University of Illinois at Chicago, Illinois.
Elijah
E
Odoyo-June
John H
JH
Rogers
Walter
W
Jaoko
Robert C
RC
Bailey
D000293:Adolescent; D000328:Adult; D018791:CD4 Lymphocyte Count; D002944:Circumcision, Male; D015331:Cohort Studies; D015658:HIV Infections / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000302:isolation & purification*; D006801:Humans; D007630:Kenya; D008297:Male; D010413:Penis / Q000821:virology*; D010949:Plasma / Q000821:virology*; D011446:Prospective Studies; D019562:Viral Load; D017201:Virus Shedding; D055815:Young Adult