La circoncisione maschile non fornisce alcun beneficio diretto per le donne
Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial
Circoncisione di uomini con infezione da HIV non ridurre la trasmissione dell'HIV ai loro partner sessuali femminili non infetti da oltre due anni in uno studio randomizzato di prova fra 450 coppie in Uganda. La prova è stata effettuata a causa di un precedente studio osservazionale aveva suggerito che i partner di uomini HIV-positivi avevano meno probabilità di acquisire l'HIV se gli uomini sono stati circoncisi. I risultati confermano inoltre che gli uomini con infezione da HIV che fanno sesso prima della cicatrizzazione completa della ferita in seguito a una circoncisione, possono essere ad aumentato rischio di trasmissione del virus. "La stretta osservanza di astinenza sessuale durante la guarigione della ferita e l'uso del preservativo deve essere coerente in seguito fortemente promosso", scrivono gli autori. Un commento sulle note di studio che le donne con partner circoncisi sono anche a maggior rischio di diverse infezioni trasmesse sessualmente.
922 uncircumcised, HIV-infected, asymptomatic men aged 15—49 years with CD4-cell counts 350 cells per μL or more were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned by computer-generated randomisation sequence to receive immediate circumcision (intervention; n=474) or circumcision delayed for 24 months (control; n=448). HIV-uninfected female partners of the randomised men were concurrently enrolled (intervention, n=93; control, n=70) and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment (primary outcome). A modified intention-to-treat (ITT) analysis, which included all concurrently enrolled couples in which the female partner had at least one follow-up visit over 24 months, assessed female HIV acquisition by use of survival analysis and Cox proportional hazards modelling. This trial is registered with ClinicalTrials.gov, number NCT00124878.
The trial was stopped early because of futility. 92 couples in the intervention group and 67 couples in the control group were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0·36). Cumulative probabilities of female HIV infection at 24 months were 21·7% (95% CI 12·7—33·4) in the intervention group and 13·4% (6·7—25·8) in the control group (adjusted hazard ratio 1·49, 95% CI 0·62—3·57; p=0·368).
Circumcision of HIV-infected men did not reduce HIV transmission to female partners; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.
(da TheLancet-National Institutes of Health)
Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial
Circoncisione di uomini con infezione da HIV non ridurre la trasmissione dell'HIV ai loro partner sessuali femminili non infetti da oltre due anni in uno studio randomizzato di prova fra 450 coppie in Uganda. La prova è stata effettuata a causa di un precedente studio osservazionale aveva suggerito che i partner di uomini HIV-positivi avevano meno probabilità di acquisire l'HIV se gli uomini sono stati circoncisi. I risultati confermano inoltre che gli uomini con infezione da HIV che fanno sesso prima della cicatrizzazione completa della ferita in seguito a una circoncisione, possono essere ad aumentato rischio di trasmissione del virus. "La stretta osservanza di astinenza sessuale durante la guarigione della ferita e l'uso del preservativo deve essere coerente in seguito fortemente promosso", scrivono gli autori. Un commento sulle note di studio che le donne con partner circoncisi sono anche a maggior rischio di diverse infezioni trasmesse sessualmente.
922 uncircumcised, HIV-infected, asymptomatic men aged 15—49 years with CD4-cell counts 350 cells per μL or more were enrolled in this unblinded, randomised controlled trial in Rakai District, Uganda. Men were randomly assigned by computer-generated randomisation sequence to receive immediate circumcision (intervention; n=474) or circumcision delayed for 24 months (control; n=448). HIV-uninfected female partners of the randomised men were concurrently enrolled (intervention, n=93; control, n=70) and followed up at 6, 12, and 24 months, to assess HIV acquisition by male treatment assignment (primary outcome). A modified intention-to-treat (ITT) analysis, which included all concurrently enrolled couples in which the female partner had at least one follow-up visit over 24 months, assessed female HIV acquisition by use of survival analysis and Cox proportional hazards modelling. This trial is registered with ClinicalTrials.gov, number NCT00124878.
The trial was stopped early because of futility. 92 couples in the intervention group and 67 couples in the control group were included in the modified ITT analysis. 17 (18%) women in the intervention group and eight (12%) women in the control group acquired HIV during follow-up (p=0·36). Cumulative probabilities of female HIV infection at 24 months were 21·7% (95% CI 12·7—33·4) in the intervention group and 13·4% (6·7—25·8) in the control group (adjusted hazard ratio 1·49, 95% CI 0·62—3·57; p=0·368).
Circumcision of HIV-infected men did not reduce HIV transmission to female partners; longer-term effects could not be assessed. Condom use after male circumcision is essential for HIV prevention.
(da TheLancet-National Institutes of Health)
