Male circumcision retains effectiveness at reducing risk of HIV infection: 54 month results

A late breaker by Bailey and Colleagues presented at the International AIDS Conference reported on the follow-up to the randomized male medical circumcision trial conducted in Kisumu, Kenya, involving 2874 men aged 18 to 24 years at enrollment. [1]

The authors had previously reported a 60% protective effect of male circumcision against HIV acquisition at 24 months after enrollment, and 64% at 42 months. This poster indicates that this protective effect extends to at least 54 months after enrollment.

As of March 2010, 1552/1740 men (89%) consented to extended follow-up: 767 in the circumcision group and 785 in the control group. The age and number of sexual partners at baseline were the same in both groups. 49% (387/795) of those in the control group have been circumcised since December 2006.

The number of HIV seroconversions by 54 months of follow-up was 39 in the circumcised group and 79 in the uncircumcised group (RR = 0.34; 95%CI: 0.23-0.51). The estimated cumulative incidence [95% CI] at 54 months was 4.0% [95%CI: 2.8-5.7] in the circumcised group and 10.6% [95%CI: 8.2-13.6] in the uncircumcised group (p<0.0002, RR=0.36; 95%CI: 0.24-0.55). The annualised incidence in the circumcised group was 0.91 per 100 person-years and 2.45 per 100 person-years in the uncircumcised group (p=0.0007).

The authors conclude that they found that the 60% protective effect of circumcision against HIV acquisition over 24 months is sustainable, and possibly strengthened, over 54 months of study. They write that these results provide support for policy makers, donors and implementers to scale up comprehensive, safe, voluntary medical male circumcision in appropriate regions as rapidly as possible.

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This important finding demonstrates the lasting preventative effect of voluntary male medical circumcision. On 14 July the Bophelo Pele Male Circumcision Project in Orange Farm, one of the sites for the other two randomised controlled trials that showed the efficacy of circumcision, announced that they had reached the milestone of 20,000 safe circumcisions.

This intervention has long-term efficacy and has been proven that it can be conducted at scale and safely. It is therefore sensible to roll it out in areas with large heterosexual epidemics. It needs to be scaled up across sub-Saharan Africa.