Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.
Randomized, controlled intervention trial of male circumcision for reduction of HIV infection risk: the ANRS 1265 Trial.
Blog Article
BACKGROUND: Observational studies suggest that male circumcision may provide protection against HIV-1 infection.A randomized, controlled intervention trial was conducted in a general population of South Africa to test this hypothesis.METHODS AND FINDINGS: A total of 3,274 uncircumcised men, aged 18-24 y, were randomized to a control or an intervention group with follow-up visits at months 3, 12, and 21.
Male circumcision was offered to the intervention group immediately after randomization and to the control group at the end of the follow-up.The grouped censored data were analyzed in intention-to-treat, univariate and multivariate, analyses, using piecewise exponential, proportional hazards models.Rate TEA TREE ratios (RR) of HIV incidence were determined with 95% CI.
Protection against HIV infection was calculated as 1 - RR.The trial was stopped at the interim analysis, and the mean (interquartile range) follow-up was 18.1 mo (13.
0-21.0) when the data were analyzed.There were 20 HIV infections (incidence rate = 0.
85 per 100 person-years) in the intervention group and 49 (2.1 per 100 person-years) in the control group, corresponding to an RR of 0.40 (95% CI: 0.
24%-0.68%; p < 0.001).
This RR corresponds to a protection of 60% (95% CI: 32%-76%).When controlling for behavioural factors, including sexual behaviour that increased slightly in the intervention group, condom use, and health-seeking behaviour, the protection was of 61% (95% CI: 34%-77%).CONCLUSION: Male circumcision provides a degree of protection against acquiring HIV infection, equivalent to what a vaccine of high efficacy would have achieved.
Male circumcision may provide an important way of reducing the spread of HIV infection in sub-Saharan Africa.(Preliminary and partial results were presented at the International AIDS Society 2005 Conference, on 26 July 2005, in Slings Rio de Janeiro, Brazil.).