Mehta circ hsv2 gud hiv manuscript AIDS REVISION 1-17-12 Final no Ndinya (2).pdf (153.7 kB)
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Circumcision Status and Incident HSV-2 Infection, Genital Ulcer Disease, and HIV Infection

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journal contribution
posted on 05.12.2013, 00:00 authored by Supriya D. Mehta, Stephen Moses, Corette B. Parker, Kawango Agot, Ian Maclean, Robert C. Bailey
Objective: We assessed the protective effect of medical male circumcision (MMC) against HIV, HSV-2, and GUD incidence. Design: 2784 men aged 18–24 years living in Kisumu, Kenya were randomly assigned to circumcision (n=1391) or delayed circumcision (n=1393), and assessed by HIV and HSV-2 testing and medical examinations during follow-ups at 1, 3, 6, 12, 18, and 24 months. Methods: Cox regression estimated the risk ratio (RR) of each outcome (incident HIV, GUD, HSV-2) for circumcision status and multivariable models estimated HIV risk associated with HSV-2, GUD and circumcision status as time-varying covariates. Results: HIV incidence was 1.42 per 100 person-years. Circumcision was 62% protective against HIV [RR=0.38; 95% CI: 0.22 - 0.67], and did not change when controlling for HSV-2 and GUD [RR=0.39; 95% CI: 0.23 - 0.69]. GUD incidence was halved among circumcised men [RR=0.52, 95% CI: 0.37 - 0.73]. HSV-2 incidence did not differ by circumcision status [RR=0.94; 95% CI: 0.70 - 1.25]. In the multivariable model, HIV seroconversions were tripled [RR=3.44; 95% CI: 1.52 - 7.80] among men with incident HSV-2 and 7 times greater [RR=6.98; 95% CI: 3.50 - 13.9] for men with GUD. Conclusion: Contrary to findings from the South African and Ugandan trials, the protective effect of MMC against HIV was independent of GUD and HSV-2 and MMC had no effect on HSV-2 incidence. Determining the causes of GUD is necessary to reduce associated HIV risk, and to understand how circumcision confers protection against GUD and HIV.


This trial was supported by grant number AI50440 from the NIAID, Division of AIDS, NIH; and by grant number HCT 44180 from the Canadian Institutes of Health Research.


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Post print version of article may differ from published version. The final publication is available at; DOI 10.1097/QAD.0b013e328352d116


Lippincott, Williams & Wilkins





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