You have full text access to this OnlineOpen article

Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11 050 men†

  1. E Mills1,
  2. C Cooper2,
  3. A Anema1,
  4. G Guyatt3

Article first published online: 8 JUL 2008

DOI: 10.1111/j.1468-1293.2008.00596.x

Issue

HIV Medicine

HIV Medicine

Volume 9, Issue 6, pages 332–335, July 2008

Additional Information

How to Cite

Mills, E., Cooper, C., Anema, A. and Guyatt, G. (2008), Male circumcision for the prevention of heterosexually acquired HIV infection: a meta-analysis of randomized trials involving 11 050 men. HIV Medicine, 9: 332–335. doi: 10.1111/j.1468-1293.2008.00596.x

Author Information

  1. 1

    St Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada,

  2. 2

    Division of Infectious Diseases, Ottawa Hospital, University of Ottawa, ON, Canada

  3. 3

    Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada

* Dr Edward Mills, St Paul's Hospital, British Columbia Centre for Excellence in HIV/AIDS, 608-1081 Burrard Street, Vancouver, BC, Canada V6Z 1Y6. Tel: +1 604 806 3727; fax: +1 604 806 9044; e-mail: emills@mail.cihhrs.org

  1. †

    *See editorial by Lazarus et al. [‡] on pp. 327–328 and article by Rice et al. [§] on pp. 329–331 in this same issue.

Publication History

  1. Issue published online: 8 JUL 2008
  2. Article first published online: 8 JUL 2008
  3. Received: 12 October 2007, accepted 11 April 2008

SEARCH

SEARCH BY CITATION

ARTICLE TOOLS

View Full Article (HTML) Get PDF (72K)

Keywords:

  • circumcision;
  • HIV/AIDS;
  • meta-analysis;
  • prevention

Objectives

Observational studies and a small collection of randomized controlled trials (RCTs) suggest that male circumcision may significantly reduce HIV transmission between sero-discordant contacts. The Joint United Nations Programme on HIV/AIDS (UNAIDS) and World Health Organization have recently announced recommendations to scale up male circumcision in countries with generalized epidemics and low levels of male circumcision. However, no meta-analysis has been conducted to determine the effectiveness of this intervention.

Methods

We conducted a systematic review of medical literature, and included any RCTs assessing male circumcision to prevent heterosexually acquired HIV infection among males. We used the DerSimonian–Laird random effects method to pool study outcomes. We calculated the relative risk (RR), risk difference, number needed to treat (NNT) and I2, all with 95% confidence intervals (CIs).

Results

We identified three RCTs that met our inclusion criteria, involving a total of 11 050 men. The pooled RR was 0.44 (95% CI 0.33–0.60, P<0.0001, I2=0%, 95% CI 0–35%). The risk difference was 0.014 (95% CI 0.07–0.21), yielding a NNT of 72 (95% CI 50–143).

Conclusions

Male circumcision is an effective strategy for reducing new male HIV infections. Its impact on a population level will require consistently safe sexual practices to maintain the protective benefit.

View Full Article (HTML) Get PDF (72K)