Why circumcision reduces HIV risk

By: Public Library of Science
Source: Science Daily
Website: https://www.sciencedaily.com/releases/2009/11/091123212540.htm

The decreased risk of HIV infection in circumcised men cannot be explained by a reduction in sores from conditions such as herpes, according to research published in PLoS Medicine.

In further analyses of data from 2 clinical trials including more than 5,000 men in rural Uganda, which had shown that circumcision reduced the risk of HIV infection in men by about 60%, Ron Gray of the Johns Hopkins Bloomberg School of Public Health and colleagues investigated factors associated with that reduction in risk. Specifically, they investigated whether infection with HSV-2, the virus that causes genital herpes, and whether genital ulcers of any cause, could account for the lower rates of HIV infection in the circumcised study participants.52

The researchers found that reduction in symptomatic genital ulcer disease accounted for only about 10% of the protective effect associated with circumcision, and did not find any consistent role for HSV-2 in counteracting protection. These results indicate that most of the reduction in HIV acquisition provided by male circumcision may be explained by the removal of vulnerable foreskin tissue containing HIV target cells. They also suggest that circumcision reduces genital ulcer disease primarily by reducing the rate of ulceration due to causes other than herpes, including sores caused by mild trauma during intercourse.

The trials were funded by the US National Institutes of Health (#U1AI51171), the Bill & Melinda Gates Foundation (#22006.02), and the Fogarty International Center (#5D43TW001508 and #D43TW00015). This study was also supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, NIH.

Vasectomy may increase risk of aggressive prostate cancer

By: Harvard School of Public Health
Source: Science Daily
Website: https://www.sciencedaily.com/releases/2014/07/140709182240.htm

Vasectomy was associated with a small increased risk of prostate cancer, and a stronger risk for advanced or lethal prostate cancer according to a new study from Harvard School of Public Health (HSPH). The researchers found that the association remained even among men who received regular PSA screening, suggesting the increased risk of lethal cancer cannot be explained by diagnostic bias. It is the largest and most comprehensive study to date to look at the link between vasectomy and prostate cancer.

The study appears online July 7, 2014 in Journal of Clinical Oncology.

"This study follows our initial publication on vasectomy and prostate cancer in 1993, with 19 additional years of follow-up and tenfold greater number of cases. The results support the hypothesis that vasectomy is associated with an increased risk of advanced or lethal prostate cancer," said co-author Lorelei Mucci, associate professor of epidemiology at HSPH.51

Vasectomy is a common form of contraception in the U.S., with about 15% of men having the procedure. Prostate cancer is the second-leading cause of cancer death among U.S. men, so identifying risk factors for lethal prostate cancer is important for public health.

The researchers analyzed data from 49,405 U.S. men in the Health Professionals Follow-up Study, who were followed for up to 24 years from 1986 to 2010. During that time, 6,023 cases of prostate cancer were diagnosed, including 811 lethal cases. One in four of the men in this study reported having a vasectomy.

The results showed a 10% increased risk of prostate cancer overall in men who had a vasectomy. Vasectomy was not significantly associated with risk of low-grade cancer. However, vasectomy was associated with a stronger risk of advanced and lethal prostate cancer, with an increased risk of 20% and 19% respectively. Among men who received regular PSA screening, the relative increase in risk of lethal prostate cancer was 56%. The effect appeared to be stronger among men who had a vasectomy at a younger age.

Prior work on this topic raised concerns that the positive associations could be linked to bias. However, in the present study, the researchers had access to diverse information and could rule out potential biases, including that men who have vasectomies may seek more medical care in general, that they may have a higher rates of PSA screening, or that the association was due possible confounding by sexually transmitted infections.

In this study, 16 in 1,000 men developed lethal prostate cancer during 24 years of follow-up. Although the relative increase in the risk associated with vasectomy was significant, this translates to a relatively small increase in absolute difference in the risk of lethal prostate cancer, say the researchers. "The decision to opt for a vasectomy as a form of birth control is a highly personal one and a man should discuss the risks and benefits with his physician," said co-author Kathryn Wilson, research associate in the Department of Epidemiology at HSPH.

Circumcision Doesn't Reduce Sexual Satisfaction

By: Blackwell Publishing Ltd.
Source: Science Daily
Website: https://www.sciencedaily.com/releases/2008/01/080107101013.htm

Circumcision Doesn't Reduce Sexual Satisfaction And Performance, Says Study Of 4,500 Men

More than 98 per cent of men who are circumcised can enjoy the same levels of sexual satisfaction and performance as men who are not, according to a study of nearly 4,500 males published in the January issue of the UK-based urology journal BJU International.

The randomised trial, carried out by researchers from Uganda and the USA, was undertaken because previous studies showed that the procedure -- which is now recommended as an efficient way to reduce HIV transmission - showed conflicting results.

"Previous studies have been problematic and shown contradictory results" points out co-author Professor Ronald H Gray from the Bloomberg School of Health at Johns Hopkins University, Baltimore, USA.

"Studies focusing on men circumcised in adulthood were highly selective, because there were medical indications for surgery, circumcised infants can't provide before and after comparisons and in most studies sample sizes were small and follow-up was short.

"This study, carried out as part of an HIV prevention initiative, enabled us to compare two groups of men with the same demographic profiles and levels of sexual satisfaction and performance at the start of the study."

The research team looked at 4,456 sexually experienced Ugandan men aged from 15 to 49 who did not have the HIV virus. 2,210 were randomised to receive circumcision and 2,246 had their circumcision delayed for 24 months.

They followed up both sets of men at six, 12 and 24 months and then compared the information on sexual desire, satisfaction and sexual performance for the circumcised men and the control group.

Their research showed that:39

98.6 per cent of the circumcised men reported no problems in penetration, compared with 99.4 per cent of the control group.
99.4 per cent of the circumcised men reported no pain on intercourse, compared with 98.8 per cent of the control group.

Sexual satisfaction was more or less constant in the circumcision group -- 98.5 per cent on enrolment and 98.4 per cent after two years -- but rose slightly from 98 per cent to 99.9 per cent in the control group. This difference was not felt to be clinically significant.

At the six-month visit there was a small, but statistically significant, difference in problems with penetration and pain among the circumcised group, but this was temporary and was not reported at subsequent follow-up visits.

There was considerable consistency between the men in each group when it came to age, religion, marital status, education and number of sexual partners in the last year. The majority of the men were Catholic, married, had one sexual partner and were educated to primary school level.

"Our study clearly shows that being circumcised did not have an adverse effect on the men who underwent the procedure when we compared them with the men who had not yet received surgery" concludes Professor Gray.

"Other studies have already shown that being able to reassure men that the procedure won't affect sexual satisfaction or performance makes them much more likely to be circumcised."

"BJU International was very keen to publish this large-scale study as there has been a lot of conflicting evidence about the effects of circumcision" says the journal's Editor, Professor John Fitzpatrick from University College Dublin, Ireland.

"We believe that these findings are very important as they can be used to support public health messages that promote circumcision as an effective way of reducing HIV transmission."

The effect of male circumcision on sexual satisfaction and function, results from a randomized trial of male circumcision for human immunodeficiency virus prevention. Rakai, Uganda. Kigozi et al. BJU International. Volume 101, pp 65-70. January 2008.

Male circumcision, HIV treatment can significantly reduce new

By: ohns Hopkins University Bloomberg School of Public Health
Source: Science Daily
Website: https://www.sciencedaily.com/releases/2016/07/160712115340.htm

Male circumcision, HIV treatment can significantly reduce new infections in African men
Researchers confirm in real-world settings that these combined prevention strategies work

Increasing the number of men who undergo circumcision and increasing the rates at which women with HIV are given antiretroviral therapy (ART) were associated with significant declines in the number of new male HIV infections in rural Ugandan communities, new Johns Hopkins Bloomberg School of Health research suggests.

The research, published July 12 in the Journal of the American Medical Association (JAMA), is believed to be the first to show that two promising prevention methods that w40ere successful in tightly controlled clinical trial settings have real-world effects. The findings suggest that further scale-up of these programs throughout sub-Saharan Africa could slow the HIV epidemic in the region.

"The biology of these two prevention strategies has been proven, but the big question was whether these strategies could have an impact on the number of new HIV infections in communities still struggling to control the spread of the disease," says study leader Xiangrong Kong, PhD, an associate scientist in the departments of Epidemiology and Biostatistics at the Bloomberg School. "Before our study, there was no empirical data to show the effects of scaling up these two interventions in real-world settings. It's important to know whether prevention is working and this is evidence that strongly suggests that African nations should redouble their efforts to scale up these programs."

The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimates there are roughly 25.8 million people living with HIV in sub-Saharan Africa. In 2014, approximately 41 percent were on ART, though coverage rates vary widely. The World Health Organization estimates that between 2007 and 2015, more than 10 million men had been circumcised in 14 priority countries in this region. Given the findings of the new study, these circumcisions should have a dramatic impact on new HIV infections going forward.

For the study, Kong and her colleagues used data collected from surveys between 1999 and 2013 in 45 communities in rural Rakai District in south-central Uganda, which included data on community-level ART coverage, male circumcision coverage, sociodemographics, sexual behaviors, HIV prevalence and rates of new HIV infections. They looked at three distinct periods: prior to the availability of ART and circumcision (1999-2004), during early availability of ART and circumcision and during full program scale up of both (2007-2013).

Over the study period, the median community coverage of male circumcision increased from 19 percent to 39 percent and median ART coverage increased from 0 percent to 21 percent in males and from 0 percent to 23 percent in females. The World Health Organization's target is for 80 percent of men in sub-Saharan Africa to be circumcised.

The researchers found that in communities where more than 40 percent of men had been circumcised, the rate of new infections among men was reduced by 39 percent as compared to those communities where 10 percent or fewer men had been circumcised. They also found that in communities where more than 20 percent of HIV-infected women were taking ART, there was a 23 percent reduction in rates of new HIV infections in men, as compared to communities where 20 percent or fewer of the HIV-infected women were taking the medications. No reduction was seen in HIV rates among women, but Kong says that may come going forward as male ART use increases.

Studies have shown that male circumcision provides direct protection against male HIV acquisition by removing the foreskin, which is rich in HIV target cells. Convincing adult men to be circumcised is not an easy sell, Kong says, but results like these can go a long way toward expanding coverage in communities.

Kong says that low ART coverage observed in their study could be a result of WHO's guidelines for how early to start antiretroviral treatment. During much of the study period, only people with evidence of impaired immunity in their blood were given the treatment. Now that it is understood that ART is vital not just as a treatment but as a preventive measure in that it reduces how contagious someone is, guidelines recommend that it be prescribed upon diagnosis, irrespective of evidence of immune impairment.

Scaling up these prevention strategies isn't cheap, Kong concedes, but studies have shown that doing these two strategies together can be more cost-effective. Still, she says, international resources for treatment and prevention have remained flat since 2008. In the meantime, public health awareness programs need to be boosted to get more people tested and treated and get men into circumcision programs.

"We still have a long way to go in curbing the HIV epidemic in Africa," she says. "People need to adopt these strategies, and we need to have sustainable funding to support these efforts.

Low rate of adverse events associated with male

By: https://www.sciencedaily.com/releases/2014/05/140512214045.htm
Source: Science Daily
Website: https://www.sciencedaily.com/releases/2014/05/140512214045.htm

Low rate of adverse events associated with male circumcision during first year of life, study finds

A low rate of adverse events (AEs) was associated with male circumcision (MC) when the procedure was performed during the first year of life, but the risk was 10 to 20 times higher when boys were circumcised after infancy.

The American Academy of Pediatrics has updated its MC guidance to say that the benefits justify access to the procedure for families who38 choose it. There has been debate about whether MC should be considered a public health action because of its potential protective effect against acquisition of human immunodeficiency virus (HIV) as suggested in three randomized controlled trials. A part of the debate surrounds the rate of AEs.

The authors selected 41 possible AEs of MC based on a literature review and medical billing codes. They used data from a large administrative claims data set and records were available for about 1.4 million circumcised males (93.3 percent as newborns).

The rate of total AEs from MC was slightly less than 0.5 percent. The rates of potentially serious AEs from MC ranged from 0.76 per million MCs for stricture of the male genital organs to 703.23 per million for repair of an incomplete circumcision. Compared with boys circumcised at younger than 1 year of age, the incidence of probable AEs was 20-fold and 10-fold greater for boys circumcised at age 1 to 9 years and at 10 years or older.

"Given the current debate about whether MC should be delayed from infancy to adulthood for autonomy reasons, our results are timely and can help physicians counsel parents about circumcising their sons," the researchers concluded.

Latest Blogs

No Internet Connection