The likelihood of viral shedding from male circumcision wounds intially increases, then decreases as the wounds heal, and is lower in patients with lower plasma viral load, according to a study published this week in PLOS Medicine. The study, conducted by Aaron Tobian, of Johns Hopkins University, Baltimore, MD and the Rakai Health Sciences Program, Entebbe, Uganda, and colleagues, monitored 223 HIV-infected men for wound healing and viral shedding from their surgical wounds for 12 weeks following voluntary medical male circumcision.
The researchers found that, compared to specimens obtained from washings of the surgical site before circumcision, HIV viral shedding in the area of the surgical site was more common in weeks 1, 2, and 3 after surgery, (by 87%, 216% and 98% of men, respectively). However, by six weeks after surgery, all wounds had healed and viral shedding decreased. Compared to baseline, shedding was detected in 73% and 81% fewer men at weeks 6 and 12 after surgery, respectively. Overall, they found that viral shedding from the surgical site was 88% less common in visits from men with healed surgical wounds compared to men whose wounds were still healing.
In addition to wound healing, lower amounts of virus in the blood was also associated with less viral shedding. At enrollment, 40 men reported being on antiretroviral treatment (ART), 29 of whom had undetectable plasma viral load. HIV shedding was more 10 times less likely in men with low or undetectable plasma viral load (<400 copies/ml) than in visits from men with high plasma viral load (>50,000 copies/ml), and when virus was detected in washings from the wounds of men with ART-suppressed viral loads, it was at lower levels than in men not on ART.
The authors say:
"The findings from this study reinforce the need for male circumcision programs to provide voluntary HIV counseling and testing prior to MC, promote sexual abstinence during wound healing and condom use thereafter, offer free condoms, and encourage counseling for HIV-infected men and their sexual partners on the risk of HIV transmission if sexual intercourse is resumed prior to complete wound healing."
Funding: This study was supported by the Bill & Melinda Gates Foundation (22006.03, sample collection), the Doris Duke Charitable Foundation (#2011036, laboratory work), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases and the Fogarty International Center, 1D43TWOO9578-01. AART was supported by the NIH 1K23AI093152-01A1 and the Doris Duke Charitable Foundation Clinician Scientist Development Award. MKG was supported by NIH T32AI102 and the Doris Duke Charitable Foundation Clinician Scientist Development Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: JL is a member of the Editorial Board of PLOS Medicine. All other authors have declared that no competing interests exist.
Citation: Tobian AAR, Kigozi G, Manucci J, Grabowski MK, Serwadda D, et al. (2015) HIV Shedding from Male Circumcision Wounds in HIV-Infected Men: A Prospective Cohort Study. PLoS Med 12(4): e1001820. doi:10.1371/journal.pmed.1001820
Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America; Rakai Health Sciences Program, Entebbe, Uganda; Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America; Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America; Institute of Public Health, Makerere University, Kampala, Uganda; Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America;
Aaron A. R. Tobian Johns Hopkins University email@example.com