HIV Health News

New Data on Male Circumcision

On December 12, the National Institutes of Health halted two male circumcision trials after interim data showed that the procedure reduced the risk of HIV acquisition by half. Infection rates dropped by 48% and 53% in controlled trials in Uganda and Kenya, respectively. (Researchers are now offering the procedure to participants originally assigned to the non-circumcision arms of both studies.) These results concur with findings reported in 2005 from a trial in Orange Farm, South Africa, which found at least a 60% reduction in HIV infection among circumcised men.

Circumcision is thought to eliminate a potential route of viral entry by removing tissue that contains HIV-susceptible immune cells very near the surface. Although the intervention does not guarantee full protection, researchers and public health experts estimate that routine male circumcision throughout Africa could prevent two million HIV infections and 300,000 deaths over the next ten years. "We now have confirmation -- from large, carefully controlled, randomized clinical trials -- showing definitively that medically performed circumcision can significantly lower the risk of adult males contracting HIV through heterosexual intercourse," said Anthony Fauci, MD, Director of the National Institutes of Allergy and Infectious Diseases.

As with any HIV prevention strategy, effective risk reduction requires both acceptability and successful implementation. In a joint statement issued on December 13, the World Health Organization, the United Nations Population Fund, UNICEF, the World Bank, and the UNAIDS Secretariat announced that they are developing policy recommendations to guide implementation of the new intervention: "Countries or healthcare institutions which decide to offer male circumcision more widely as an additional way to protect against HIV infection must ensure that it is performed safely by welltrained practitioners in sanitary settings under conditions of informed consent, confidentiality, risk-reduction counseling, and safety." The agencies emphasized that circumcision "should never replace other known effective prevention methods and should always be considered as part of a comprehensive prevention package."

Microbicide Candidate Trials Halted

In late January, the reproductive health organization CONRAD halted a Phase III clinical trial of cellulose sulfate, a microbicide gel, after preliminary results from study sites in Benin, South Africa, Uganda, and India linked the product with increased risk of HIV infection. Family Health International halted another trial in Nigeria, although higher infection rates were not seen in that study. Cellulose sulfate, also called UsherCell, is one of dozens of experimental microbicides -- chemicals applied inside the vagina or rectum to prevent HIV infection. Eleven previous trials of cellulose sulfate raised no safety concerns, and researchers are investigating why use of the gel was associated with greater risk in the CONRAD study. "While the findings are unexpected and disappointing," said principal investigator Dr. Lut Van Damme, "we will learn scientifically important information from this trial that will inform future HIV prevention research."

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