Circumcision may reduce HIV risk among men who have sex with men
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Key takeaways:
- Voluntary medical male circumcision reduced the risk for HIV among men who have sex with men in a study.
- The procedure may be useful in countries where PrEP use is not widespread.
Voluntary medical male circumcision can reduce the risk for HIV acquisition among men who have sex with men who primarily practice insertive anal sex, according to the results of a randomized controlled trial conducted in China.
Previous findings have suggested that circumcision can reduce HIV transmission during sex between men and women, but the new study, presented at the International AIDS Society Conference on HIV Science in Brisbane, Australia, is the first to show the procedure may effectively limit transmission among men who have sex with men (MSM).
Charles F. Gilks, MBBS, DPhil, dean of the School of Public Health at the University of Queensland, said during a press briefing that three randomized trials in southern Africa showed voluntary medical male circumcision (VMMC) reduced HIV transmission between men and women by 50% to 60%, and modeling studies have suggested the procedure has prevented hundreds of thousands of infections.
The scale up of both VMMC availability and ART in Uganda starting in 2006 was shown to reduce HIV transmission by between 40% and 60% among men and women, according to a study published in 2020.
Previous studies conducted among MSM were observational, Gilks said, “and those studies had quite mixed results. This study is notable because it’s the first randomized controlled trial to assess the efficacy of VMMC in a population of men who have sex with men.”
Yanxiao Gao, a postgraduate doctoral student at Sun Yat-sen University in Shenzhen, China, and colleagues conducted the randomized controlled trial in eight cities in China, recruiting 247 uncircumcised, HIV-negative men aged 18 to 49 years who predominantly practiced insertive anal sex and had at least two partners in the preceding 6 months.
They split participants into two groups — 124 in an intervention group who underwent VMMC and 123 who did not undergo VMMC. Participants were tested for HIV at 3, 6, 9 and 12 months after joining the study.
The researchers report that during the study period, there were zero positive tests for HIV in the intervention group (95% CI, 0-3.18) and five positive tests in the control group (4.27; 95% CI, 1.38-9.97). Additionally, all adverse events related to VMMC were “mild and resolved quickly.”
Gao and colleagues concluded that VMMC is “very likely to be efficacious” in preventing HIV infection among MSM but that larger scale trials with longer term follow-up should be conducted to confirm the findings.
Gilks said that although it is anticipated that “PrEP rollout will continue to be the priority in most settings,” VMMC may be added as an HIV prevention tool.
Huachun Zou, PhD, professor of epidemiology at Sun Yat-sen University, said at a press briefing that based on conversations he has had with clinicians and health officials around the world, there appears to be less desire to investigate VMMC as an option.
“I think they have comparatively less interest in doing a randomized controlled trial in their country because PrEP is there and all the biomedical prevention measures are there,” Zou said.
In the United States, for example, outreach programs have been created across the country to increase PrEP use among people most at risk for HIV.
Zou added, however, that countries like China, where PrEP is not widely accepted and more promotion of its use is needed, could benefit from VMMC.
“The circumcision rate in some countries is already very high,” Zou said. “But in China ... the circumcision rate is less than 10% and PrEP is not widely used here, so I think China is one of the places [that should] have circumcision as an option.”
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Gao Y, et al. Abstract 1002. Presented at: International AIDS Society Conference on HIV Science; July 23-26, 2023; Brisbane, Australia.
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