A Cochrane review [Abstract] 1 included 3 studies with a total of 11 054 subjects. The studies were conducted in South Africa, Uganda and Kenya, and included men from the general population. All 3 studies were stopped early due to significant findings at interim analyses. The survival estimates for all three trials at 12 months, and at 21 or 24 months were combined in a meta-analysis using available case analyses using the random effects model. The resultant incidence risk ratio (IRR) was 0.50 at 12 months (95% CI 0.34 to 0.72) and 0.46 at 21 or 24 months (95% CI 0.34 to 0.62). These can be interpreted as a relative risk reduction of acquiring HIV of 50% at 12 months and 54% at 21 or 24 months following circumcision. The results obtained by sensitivity analyses (meta-analyses of the reported IRRs, the reported per protocol IRRs, and reported full intention-to-treat analysis) did not differ markedly from the available case meta-analysis; circumcision displayed significant protective effects across all analyses.
A meta-analysis of the secondary outcomes measuring sexual behaviour for the Kenyan and Ugandan trials found no significant differences between circumcised and uncircumcised men. In the South African trial, the mean number of sexual contacts was 5.9 in the circumcision group versus 5 in the control group (p < 0.001) at the 12-month visit, and 7.5 versus 6.4 (p = 0.0015) at the 21-month visit. No other significant differences were observed. Incidence of adverse events following the surgical circumcision procedure was low in all three trials.
Primary/Secondary Keywords