Circumcision Status and Risk of HIV Acquisition during Heterosexual Intercourse for Both Males and Females: A Meta-Analysis.
In this study, we evaluated if male circumcision was associated with lower HIV acquisition for HIV (-) males and HIV (-) females during normal sexual behavior. We performed a systematic literature search of PubMed, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) databases to identify studies that compared HIV acquisition for the circumcised and uncircumcised groups. The reference lists of the included and excluded studies were also screened. Fifteen studies (4 RCTs and 11 prospective cohort studies) were included, and the related data were extracted and analyzed in a meta-analysis. Our study revealed strong evidence that male circumcision was associated with reduced HIV acquisition for HIV(-) males during sexual intercourse with females [pooled adjusted risk ratio (RR): 0.30, 95% CI 0.24 0.38, P < 0.00001] and provided a 70% protective effect. In contrast, no difference was detected in HIV acquisition for HIV (-) females between the circumcised and uncircumcised groups (pooled adjusted RR after sensitivity analysis: 0.68, 95%CI 0.40-1.15, P = 0.15). In conclusion, male circumcision could significantly protect males but not females from HIV acquisition at the population level. Male circumcision may serve as an additional approach toward HIV control, in conjunction with other strategies such as HIV counseling and testing, condom promotion, and so on.
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Jun Hao
JH
Lei
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Liang Ren
LR
Liu
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Qiang
Q
Wei
Department of Urology, Dujiangyan Medical Center/ the affiliated hospital of Chengdu University, Dujianyan, China.
Shi Bing
SB
Yan
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Lu
L
Yang
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Tu Run
TR
Song
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Hai Chao
HC
Yuan
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Xiao
X
Lv
Department of Urology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
Ping
P
Han
D002944:Circumcision, Male; D003075:Coitus; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000209:etiology* / Q000635:transmission; D020010:Heterosexuality; D006801:Humans; D008297:Male; D012737:Sex Factors