Circumcision and HIV infection: review of the literature and meta-analysis

Abstract

Thirty-five articles and a number of abstracts have been published in the medical literature looking at the relationship between male circumcision and HIV infection. Study designs have included geographical analysis, studies of high-risk patients, partner studies and random population surveys. Most of the studies have been conducted in Africa. A meta-analysis was performed on the 29 published articles where data were available. When the raw data are combined, a man with a circumcised penis is at greater risk of acquiring and transmitting HIV than a man with a non-circumcised penis (odds ratio (OR)=1.06, 95% confidence interval (CI)=1.01-1.12). Based on the studies published to date, recommending routine circumcision as a prophylactic measure to prevent HIV infection in Africa, or elsewhere, is scientifically unfounded.

Circs.org Comment

Van Howe's meta-analysis has been criticised for inappropriate and unsound methodology.[1,2] When the analysis is performed correctly, the opposite results are found.[1,2] A later systematic review concluded that there strong epidemiological evidence of a protective effect of circumcision, but recommended waiting for the results of randomised controlled trials.[3] The results of the first randomised controlled trial found that circumcision is equivalent to a vaccine with 63% efficacy.[4]

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Moses S, Nagelkerke NJ, Blanchard J. Analysis of the scientific literature on male circumcision and risk for HIV infection. Int J STD AIDS. 1999 Sep;10(9):626-8
Siegfried N, Muller M, Volmink J, Egger M, Low N, Weiss H, Walker S, Deeks J, Williamson P. Male circumcision for prevention of heterosexual acquisition of HIV in men. In: The Cochrane Library, Issue 2, 2003.
Auvert B, Puren A, Taljaard D, Lagarde E, Sitta R, Tambekou J. Impact of male circumcision on the female-to-male transmission of HIV. Paper presented at the 3rd IAS Conference on HIV Pathogenesis and Treatment, Rio de Janeiro, 24-27 July, 2005.