XVIII International AIDS Conference

Abstract

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The protective effect of adult male circumcision against HIV acquisition is sustained for at least 54 months: results from the Kisumu, Kenya trial

R.C. Bailey1, S. Moses2, C.B. Parker3, K. Agot4, I. MacLean2, J.N. Krieger5, C.F.M. Williams6, J.O. Ndinya-Achola7

1University of Illinois at Chicago, School of Public Health, Chicago, United States, 2University of Manitoba, Winnipeg, Canada, 3RTI InternationalI, Research Triangle, United States, 4Impact Research and Development Organization, Kisumu, Kenya, 5University of Washington, Seattle, United States, 6National Institute for Allergy and Infectious Diseases, DAIDS, Rockville, United States, 7University of Nairobi, Medical Microbiology, Nairobi, Kenya

Background: In a randomized controlled trial in Kisumu, Kenya, involving 2,874 men aged 18-24 years at enrollment, we previously reported a 60% protective effect of male circumcision against HIV acquisition at 24 months after enrollment, and 64% at 42 months, based on modified as-treated analyses. We now report sustained protection against HIV infection extending to at least 54 months of follow-up.
Methods: The trial was unblinded in December 2006, when all participants were offered circumcision, regardless of initial treatment assignment (immediate versus delayed circumcision). HIV/STI testing and behavioural interviews were conducted semiannually in extended follow-up. Relative risk was estimated using a modified as-treated analysis.
Results: As of March 2010, 1552 of 1740 men (89%) consented to extended follow-up (n=767 circumcision group; n=785 controls); 1469 remain on study. 619 of 1393 controls (44%) were circumcised. Age and number of sexual partners at baseline were the same in controls who did and did not elect to be circumcised. The median follow-up was 36 months. There were 36 HIV seroconversions in men randomized to circumcision and 82 in controls over 54 months. The 54 month cumulative seroincidence was 4.1% (95% CI 2.9, 5.8) among men randomized to immediate circumcision and 8.8% (7.0, 10.9) among controls (p< 0.0002). The relative risk of HIV infection in circumcised men was 0.37 (0.25, 0.54), corresponding to a 63% (46, 75) protective effect.
Conclusions: The protective effect of circumcision against HIV acquisition among sexually active men seen after 24 and 42 months of follow-up was sustained to at least 54 months. Concerns about the potential for reduced protection offered by circumcision over time appear unfounded based on follow up of 4.5 years. Our results support expeditious provision of safe, voluntary male circumcision services as part of comprehensive HIV prevention strategies.


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