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Review

Male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition: a meta‐analysis

Sanjeev C. Sharma

GKT School of Medical Education, King's College London, London, UK

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Nicholas Raison

Corresponding Author

E-mail address:nicholas.raison@kcl.ac.uk

Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK

Correspondence: Nicholas Raison, MRC Centre for Transplantation, NIHR Biomedical Research Centre ‐ King's College London, 5th Floor Tower Wing, Guy's Hospital, London SE1 9RT, UK. Tel: 0207 188 5906 Fax: 0207 188 0944.

e‐mail: nicholas.raison@kcl.ac.uk

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Shamim Khan

Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK

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Majid Shabbir

Department of Urology, Guy's and St Thomas' NHS Trust, London, UK

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Prokar Dasgupta

Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK

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Kamran Ahmed

Division of Transplantation Immunology and Mucosal Biology, Faculty of Life Sciences and Medicine, King's College London, London, UK

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First published: 12 December 2017

Abstract

We aimed to assess male circumcision for the prevention of human immunodeficiency virus (HIV) acquisition in heterosexual and homosexual men using all available data. A systematic literature review was conducted searching for studies that assessed male circumcision as a method to prevent HIV acquisition in homosexual and/or heterosexual men. PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov were searched in March 2017. A random effects model was used to calculate a pooled risk ratio (RR) and its associated 95% confidence interval (CI). In total, 49 studies were included in this meta‐analysis. The overall pooled RR for both homosexual and heterosexual men was 0.58 (95% CI 0.48–0.70), suggesting that circumcision was associated with a reduction in HIV risk. Circumcision was found to be protective for both homosexual and heterosexual men (RR: 0.80, 95% CI 0.69–0.92 and 0.28, 95% CI 0.14–0.59, respectively). Heterosexual men had a greater RR reduction (72% compared with 20% for homosexual men). There was significant heterogeneity among the studies (χ2 = 1378.34, df = 48; I2 = 97%). This meta‐analysis shows that male circumcision was effective in reducing HIV risk for both heterosexual and homosexual men.