Postpubertal circumcision not protective against HIV

WESTPORT, Mar 25 (Reuters Health) - Circumcision performed before puberty appears to reduce the risk of HIV infection, according to a multicenter team. However, "...circumcision after age 20 years is not significantly protective against HIV-1 infection."

Results of several cross-sectional African studies suggest that male circumcision may have protective effects against HIV infection, Dr. Ronald H. Gray of Johns Hopkins University in Baltimore, Maryland, and colleagues explain. However, the potential benefits of postpubescent circumcision are uncertain.

To further investigate whether later circumcision confers the same level of HIV protection as early circumcision, Dr. Gray's group conducted a cross-sectional study of 6,821 Ugandan men between the ages of 15 and 59 years. The subjects were grouped by age of circumcision: before or after the age of 12 years. In addition, the older subjects were divided into younger (13 to 20 years) or older (21 years or older) age groups

Overall, the " who were circumcised before puberty had a much reduced risk of prevalent HIV infection than men who were uncircumcised," they report in the February 25th issue of AIDS.

In the subjects who had prepubertal circumcision, they found that the multivariate adjusted odds ratio of prevalent HIV was 0.39. For the subjects who had circumcisions performed between the ages of 13 and 20 years, the adjusted odds ratio was 0.46. However, for subjects circumcised when they were 21 years or older, there was no statistically significant association between circumcision and reduced HIV risk.

Based on these findings, Dr. Gray's group concludes that circumcision before the age of 21 years is protective against HIV infection, but circumcision performed later in life is not. They also suggest that these protective effects are "...likely to be due to a biological mechanism and that there may be utility to providing circumcision to newborn infants or children, particularly if this is a cultural norm."

AIDS 1999;13:399-405.