Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data
Summary: Background: Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. Previous reviews investigating the role of circumcision in preventing HIV and other STIs among MSM were inconclusive. Many new studies have emerged...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-04-01
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| Series: | The Lancet Global Health |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2214109X18305679 |
| _version_ | 1818060887439704064 |
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| author | Tanwei Yuan, MD Thomas Fitzpatrick, BA Nai-Ying Ko, ProfPhD Yong Cai, ProfPhD Yingqing Chen, ProfPhD Jin Zhao, PhD Linghua Li, PhD Junjie Xu, ProfPhD Jing Gu, PhD Jinghua Li, PhD Chun Hao, PhD Zhengrong Yang, PhD Weiping Cai, MD Chien-Yu Cheng, MD Zhenzhou Luo, MD Kechun Zhang, MD Guohui Wu, MD Xiaojun Meng, MD Andrew E Grulich, ProfPhD Yuantao Hao, ProfPhD Huachun Zou, ProfPhD |
| author_facet | Tanwei Yuan, MD Thomas Fitzpatrick, BA Nai-Ying Ko, ProfPhD Yong Cai, ProfPhD Yingqing Chen, ProfPhD Jin Zhao, PhD Linghua Li, PhD Junjie Xu, ProfPhD Jing Gu, PhD Jinghua Li, PhD Chun Hao, PhD Zhengrong Yang, PhD Weiping Cai, MD Chien-Yu Cheng, MD Zhenzhou Luo, MD Kechun Zhang, MD Guohui Wu, MD Xiaojun Meng, MD Andrew E Grulich, ProfPhD Yuantao Hao, ProfPhD Huachun Zou, ProfPhD |
| author_sort | Tanwei Yuan, MD |
| collection | DOAJ |
| description | Summary: Background: Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. Previous reviews investigating the role of circumcision in preventing HIV and other STIs among MSM were inconclusive. Many new studies have emerged in the past decade. To inform global prevention strategies for HIV and other STIs among MSM, we reviewed all available evidence on the associations between circumcision and HIV and other STIs among MSM. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, BioMed Central, Scopus, ResearchGate, Cochrane Library, Embase, PsycINFO, Google Scholar, and websites of international HIV and STI conferences for studies published before March 8, 2018. Interventional or observational studies containing original quantitative data describing associations between circumcision and incident or prevalent infection of HIV and other STIs among MSM were included. Studies were excluded if MSM could not be distinguished from men who have sex with women only. We calculated pooled odds ratios (ORs) and their 95% CIs using random-effect models. We assessed risk of bias using the Newcastle-Ottawa scale. Findings: We identified 62 observational studies including 119 248 MSM. Circumcision was associated with 23% reduced odds of HIV infection among MSM overall (OR 0·77, 95% CI 0·67–0·89; number of estimates [k]=45; heterogeneity I2=77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I2=77%) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I2=40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I2=0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I2=0%). Interpretation: We found evidence that circumcision is likely to protect MSM from HIV infection, particularly in countries of low and middle income. Circumcision might also protect MSM from HSV and penile HPV infection. MSM should be included in campaigns promoting circumcision among men in countries of low and middle income. In view of the substantial proportion of MSM in countries of low and middle income who also have sex with women, well designed longitudinal studies differentiating MSM only and bisexual men are needed to clarify the effect of circumcision on male-to-male transmission of HIV and other STIs. Funding: National Natural Science Foundation of China, National Science and Technology Major Project of China, Australian National Health and Medical Research Council Early Career Fellowship, Sanming Project of Medicine in Shenzhen, National Institutes of Health, Mega Projects of National Science Research for the 13th Five-Year Plan, Doris Duke Charitable Foundation. |
| first_indexed | 2024-12-10T13:39:33Z |
| format | Article |
| id | doaj.art-143be34c65434389b9d206f222214238 |
| institution | Directory Open Access Journal |
| issn | 2214-109X |
| language | English |
| last_indexed | 2024-12-10T13:39:33Z |
| publishDate | 2019-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Global Health |
| spelling | doaj.art-143be34c65434389b9d206f2222142382022-12-22T01:46:44ZengElsevierThe Lancet Global Health2214-109X2019-04-0174e436e447Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global dataTanwei Yuan, MD0Thomas Fitzpatrick, BA1Nai-Ying Ko, ProfPhD2Yong Cai, ProfPhD3Yingqing Chen, ProfPhD4Jin Zhao, PhD5Linghua Li, PhD6Junjie Xu, ProfPhD7Jing Gu, PhD8Jinghua Li, PhD9Chun Hao, PhD10Zhengrong Yang, PhD11Weiping Cai, MD12Chien-Yu Cheng, MD13Zhenzhou Luo, MD14Kechun Zhang, MD15Guohui Wu, MD16Xiaojun Meng, MD17Andrew E Grulich, ProfPhD18Yuantao Hao, ProfPhD19Huachun Zou, ProfPhD20School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, ChinaSchool of Medicine, University of Washington, Seattle, WA, USADepartment of Nursing, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, TaiwanSchool of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, ChinaDepartment of Biostatistics, University of Washington, Seattle, WA, USA; Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USAShenzhen Center for Disease Control and Prevention, Shenzhen, ChinaGuangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, ChinaKey Laboratory of AIDS Immunology of the National Health and Family Planning Commission, the First Affiliated Hospital, China Medical University, Shenyang, ChinaSchool of Public Health, and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health, and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, ChinaShenzhen Center for Disease Control and Prevention, Shenzhen, ChinaGuangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, ChinaTaoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, TaiwanShenzhen Nanshan Center for Chronic Disease Control, Shenzhen, ChinaShenzhen Longhua Center for Disease Control and Prevention, Shenzhen, ChinaChongqing Municipal Center for Disease Control and Prevention, Chongqing, ChinaWuxi Municipal Center for Disease Control and Prevention, Wuxi, ChinaKirby Institute, University of New South Wales, Sydney, NSW, AustraliaSchool of Public Health, and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, ChinaSchool of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China; Shenzhen Center for Disease Control and Prevention, Shenzhen, China; School of Public Health, and Sun Yat-sen Global Health Institute, Institute of State Governance, Sun Yat-sen University, Guangzhou, China; Kirby Institute, University of New South Wales, Sydney, NSW, Australia; Correspondence to: Prof Huachun Zou, School of Public Health (Shenzhen), Sun Yat-sen University, Guangzhou 510085, ChinaSummary: Background: Men who have sex with men (MSM) are disproportionately affected by HIV and other sexually transmitted infections (STIs) worldwide. Previous reviews investigating the role of circumcision in preventing HIV and other STIs among MSM were inconclusive. Many new studies have emerged in the past decade. To inform global prevention strategies for HIV and other STIs among MSM, we reviewed all available evidence on the associations between circumcision and HIV and other STIs among MSM. Methods: In this systematic review and meta-analysis, we searched PubMed, Web of Science, BioMed Central, Scopus, ResearchGate, Cochrane Library, Embase, PsycINFO, Google Scholar, and websites of international HIV and STI conferences for studies published before March 8, 2018. Interventional or observational studies containing original quantitative data describing associations between circumcision and incident or prevalent infection of HIV and other STIs among MSM were included. Studies were excluded if MSM could not be distinguished from men who have sex with women only. We calculated pooled odds ratios (ORs) and their 95% CIs using random-effect models. We assessed risk of bias using the Newcastle-Ottawa scale. Findings: We identified 62 observational studies including 119 248 MSM. Circumcision was associated with 23% reduced odds of HIV infection among MSM overall (OR 0·77, 95% CI 0·67–0·89; number of estimates [k]=45; heterogeneity I2=77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I2=77%) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I2=40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I2=0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I2=0%). Interpretation: We found evidence that circumcision is likely to protect MSM from HIV infection, particularly in countries of low and middle income. Circumcision might also protect MSM from HSV and penile HPV infection. MSM should be included in campaigns promoting circumcision among men in countries of low and middle income. In view of the substantial proportion of MSM in countries of low and middle income who also have sex with women, well designed longitudinal studies differentiating MSM only and bisexual men are needed to clarify the effect of circumcision on male-to-male transmission of HIV and other STIs. Funding: National Natural Science Foundation of China, National Science and Technology Major Project of China, Australian National Health and Medical Research Council Early Career Fellowship, Sanming Project of Medicine in Shenzhen, National Institutes of Health, Mega Projects of National Science Research for the 13th Five-Year Plan, Doris Duke Charitable Foundation.http://www.sciencedirect.com/science/article/pii/S2214109X18305679 |
| spellingShingle | Tanwei Yuan, MD Thomas Fitzpatrick, BA Nai-Ying Ko, ProfPhD Yong Cai, ProfPhD Yingqing Chen, ProfPhD Jin Zhao, PhD Linghua Li, PhD Junjie Xu, ProfPhD Jing Gu, PhD Jinghua Li, PhD Chun Hao, PhD Zhengrong Yang, PhD Weiping Cai, MD Chien-Yu Cheng, MD Zhenzhou Luo, MD Kechun Zhang, MD Guohui Wu, MD Xiaojun Meng, MD Andrew E Grulich, ProfPhD Yuantao Hao, ProfPhD Huachun Zou, ProfPhD Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data The Lancet Global Health |
| title | Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |
| title_full | Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |
| title_fullStr | Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |
| title_full_unstemmed | Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |
| title_short | Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men: a systematic review and meta-analysis of global data |
| title_sort | circumcision to prevent hiv and other sexually transmitted infections in men who have sex with men a systematic review and meta analysis of global data |
| url | http://www.sciencedirect.com/science/article/pii/S2214109X18305679 |
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