Male Circumcision Decreases Acquisition and Increases Clearance of High-Risk Human Papillomavirus in HIV-Negative Men: A Randomized Trial in Rakai, Uganda

被引:125
|
作者
Gray, Ronald H. [1 ,7 ]
Serwadda, David [7 ,8 ]
Kong, Xiangrong [1 ]
Makumbi, Frederick [7 ,8 ]
Kigozi, Godfrey [7 ]
Gravitt, Patti E. [2 ]
Watya, Stephen [9 ]
Nalugoda, Fred [7 ]
Ssempijja, Victor [7 ]
Tobian, Aaron A. R. [4 ]
Kiwanuka, Noah [7 ,8 ]
Moulton, Lawrence H. [3 ]
Sewankambo, Nelson K. [7 ,10 ]
Reynolds, Steven J. [5 ,6 ]
Quinn, Thomas C. [5 ,6 ]
Iga, Boaz [4 ,7 ]
Laeyendecker, Oliver [5 ,6 ]
Oliver, Amy E. [5 ]
Wawer, Maria J. [1 ,7 ]
机构
[1] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Populat Family & Reprod Hlth, Baltimore, MD 21205 USA
[2] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Epidemiol, Baltimore, MD 21205 USA
[3] Johns Hopkins Univ, Bloomberg Sch Publ Hlth, Dept Int Hlth, Baltimore, MD 21205 USA
[4] Johns Hopkins Med Inst, Dept Pathol, Baltimore, MD 21205 USA
[5] Johns Hopkins Med Inst, Dept Med, Baltimore, MD 21205 USA
[6] NIAID, NIH, Bethesda, MD 20892 USA
[7] Rakai Hlth Sci Program, Kalisizo, Uganda
[8] Makerere Univ, Sch Publ Hlth, Kampala, Uganda
[9] Makerere Univ, Urol Unit, Dept Surg, Mulago Hosp, Kampala, Uganda
[10] Makerere Univ, Fac Med, Coll Hlth Sci, Kampala, Uganda
来源
JOURNAL OF INFECTIOUS DISEASES | 2010年 / 201卷 / 10期
基金
美国国家卫生研究院;
关键词
CERVICAL-CANCER; YOUNG MEN; INFECTION; PREVALENCE; PREVENTION; SITES;
D O I
10.1086/652184
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Methods. Uncircumcised human immunodeficiency virus (HIV)-negative men aged 15-49 years were randomized to immediate circumcision (intervention arm, 441 subjects) or delayed circumcision (control arm, 399 subjects). Human papillomavirus (HPV) was detected by Roche HPV Linear Array at enrollment, and at 6, 12, and 24 months. Incident high-risk HPV (HR-HPV) was estimated in men who acquired a new HR-HPV genotype. HR-HPV clearance was determined in men with prior genotype-specific HR-HPV infections. Rate ratios (RRs) and 95% confidence intervals (CIs) of HR-HPV acquisition were estimated by Poisson multiple regression. Results. Enrollment characteristics were comparable between study groups. HR-HPV incidence was 19.7 cases per 100 person-years (PYs) in the intervention arm (70 cases per 355.8 PYs) and 29.4 cases per 100 PYs (125 cases per 424.8 PYs) in the control arm (RR, 0.67; 95% CI, 0.51-0.89; P = .006). The incidence of multiple HR-HPV infections was 6.7 cases per 100 PYs in the intervention arm and 14.8 cases per 100 PYs in the control arm (RR, 0.45; 95% CI, 0.28-0.73), but there was no significant effect on single infections (RR, 0.89; 95% CI, 0.60-1.30). HR-HPV incidence was lower in the intervention arm for all genotypes and demographic/behavioral subgroups. The clearance of preexisting HR-HPV infections was 215.8 cases per 100 PYs (205 cases per 95 PYs) in the intervention arm and 159.1 cases per 100 PYs (255 cases per 160.25 PYs) in the control arm (adjusted RR, 1.39; 95% CI, 1.17-1.64). Conclusions. Male circumcision reduces the incidence of multiple HR-HPV infections and increases clearance of HR-HPV infections in HIV-uninfected men.
引用
收藏
页码:1455 / 1462
页数:8
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