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Inventi Impact: Preventive & Social Medicines

Articles

  • Inventi:had/33/12
    THE SAFETY OF ADULT MALE CIRCUMCISION IN HIVINFECTED AND UNINFECTED MEN IN RAKAI, UGANDA
    30-Jun-2012 Research 2012 : July - September
    Godfrey Kigozi, Ronald H Gray, Maria J Wawer, David Serwadda, Frederick Makumbi, Stephen Watya,\r\nFred Nalugoda, Noah Kiwanuka, Lawrence H Moulton, Michael Z Chen, Nelson K Sewankambo,\r\nFred Wabwire-Mangen, Melanie C Bacon, Renee Ridzon, Pius Opendi, Victor Sempijja, Absolom Settuba,\r\nDenis Buwembo, Valerian Kiggundu, Margaret Anyokorit, James Nkale, Nehemia Kighoma, Blake Charvat

    Background\r\nThe objective of the study was to compare rates of adverse events (AEs) related to male\r\ncircumcision (MC) in HIV-positive and HIV-negative men in order to provide guidance for MC\r\nprograms that may provide services to HIV-infected and uninfected men.\r\nMethods and Findings\r\nA total of 2,326 HIV-negative and 420 HIV-positive men (World Health Organization [WHO]\r\nstage I or II and CD4 counts . 350 cells/mm3) were circumcised in two separate but\r\nprocedurally identical trials of MC for HIV and/or sexually transmitted infection prevention in\r\nrural Rakai, Uganda. Participants were followed at 1ââ?¬â??2 d and 5ââ?¬â??9 d, and at 4ââ?¬â??6 wk, to assess\r\nsurgery-related AEs, wound healing, and resumption of intercourse. AE risks and wound healing\r\nwere compared in HIV-positive and HIV-negative men. Adjusted odds ratios (AdjORs) were\r\nestimated by multiple logistic regression, adjusting for baseline characteristics and postoperative\r\nresumption of sex. At enrollment, HIV-positive men were older, more likely to be\r\nmarried, reported more sexual partners, less condom use, and higher rates of sexually\r\ntransmitted disease symptoms than HIV-negative men. Risks of moderate or severe AEs were\r\n3.1/100 and 3.5/100 in HIV-positive and HIV-negative participants, respectively (AdjOR 0.91,\r\n95% confidence interval [CI] 0.47ââ?¬â??1.74). Infections were the most common AEs (2.6/100 in HIVpositive\r\nversus 3.0/100 in HIV-negative men). Risks of other complications were similar in the\r\ntwo groups. The proportion with completed healing by 6 wk postsurgery was 92.7% in HIVpositive\r\nmen and 95.8% in HIV-negative men (pÃ?¼0.007). AEs were more common in men who\r\nresumed intercourse before wound healing compared to those who waited (AdjOR 1.56, 95% CI\r\n1.05ââ?¬â??2.33).\r\nConclusions\r\nOverall, the safety of MC was comparable in asymptomatic HIV-positive and HIV-negative\r\nmen, although healing was somewhat slower among the HIV infected. All men should be\r\nstrongly counseled to refrain from intercourse until full wound healing is achieved.

    How to Cite this Article
    CC Compliant Citation: Kigozi G, Gray RH, Wawer MJ, Serwadda D, Makumbi F, et al.(2008) The safety of adult male circumcision in HIVinfected\r\nand uninfected men in Rakai, Uganda.PLoS Med 5(6): e116. doi:10.1371/ journal.pmed.0050116.
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