Abstract
BackgroundMedical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. We assessed the effect of MC on plasma HIV viral load in HIV-infected men in Rakai, Uganda.Methods195 consenting HIV-positive, HAART naïve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Data were also collected on baseline social demographic characteristics and CD4 counts. Change in log10 plasma viral load between baseline and follow-up visits was estimated using paired t tests and multivariate generalized estimating equation (GEE).ResultsOf the 195 men, 129 had a CD4 count ≧350 and 66 had CD4 <350 cells/mm3. Men with CD4 counts <350 had higher baseline mean log10 plasma viral load than those with CD4 counts ≧350 cells/mm3 (4.715 vs 4.217 cps/mL, respectively, p = 0.0005). Compared to baseline, there was no statistically significant increase in post-MC HIV plasma viral loads irrespective of CD4. Multivariate analysis showed that higher baseline log10 plasma viral load was significantly associated with reduction in mean log10 plasma viral load following MC (coef. = −0.134, p<0.001).ConclusionWe observed no increase in plasma HIV viral load following MC in HIV-infected, HAART naïve men.
Highlights
Three trials of male circumcision (MC) show that MC reduces male HIV acquisition by 50–60% [1,2,3]
We observed no increase in plasma HIV viral load following MC in HIV-infected, Highly active antiretroviral therapy (HAART) naıve men
This study found an increase in male plasma HIV viral load four weeks after MC5, and it was speculated that the increased viremia may be due to surgical stress and temporary immune-suppression
Summary
Three trials of male circumcision (MC) show that MC reduces male HIV acquisition by 50–60% [1,2,3]. An increase in plasma viral load following MC could lead to increased risk of HIV transmission to HIVnegative female partners [6,7]. Medical male circumcision (MC) of HIV-infected men may increase plasma HIV viral load and place female partners at risk of infection. Methods: 195 consenting HIV-positive, HAART naıve men aged 12 and above provided blood for plasma HIV viral load testing before surgery and weekly for six weeks and at 2 and 3 months post surgery. Men with CD4 counts ,350 had higher baseline mean log plasma viral load than those with CD4 counts §350 cells/mm (4.715 vs 4.217 cps/mL, respectively, p50.0005). Conclusion: We observed no increase in plasma HIV viral load following MC in HIV-infected, HAART naıve men
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