Washington, Oct 8 : There is insufficient evidence that circumcision reduces the risk of human immunodeficiency virus (HIV) infection or other sexually transmitted infections among men who have sex with men, according to an analysis of previous research.
Less is known about whether circumcision offers protection against HIV infection among men who have sex with men (MSM).
Therefore, Gregorio A. Millett, M.P.H., of the Centers for Disease Control and Prevention, Atlanta, and colleagues performed a meta-analysis of 15 studies to examine the association of circumcision status with HIV infection and other STIs among MSM.
The studies included a total of 53,567 MSM participants (52 percent of whom were circumcised).
The researchers found that the odds of being HIV-positive were nonsignificantly lower among MSM who were circumcised than uncircumcised.
On contrary, a statistically significant protective association of circumcision with HIV infection was found for MSM studies conducted prior to the introduction of highly active antiretroviral therapy (HAART) in 1996.
Of studies conducted after HAART, the association of circumcision and HIV infection was not statistically significant.
"A possible explanation for [these differences] may be related to an increase in the sexual risk behaviours of MSM after HAART. It has been well documented that beliefs that HAART limits HIV transmissibility are associated with increases in sexual risk behaviour among MSM, and that the era since the advent of HAART has been defined by higher rates of sexual risk behaviours among MSM, outbreaks of STIs, and increasing rates of HIV infection," the researchers said.
Among MSM who primarily engaged in insertive anal sex, the link between male circumcision and HIV was protective but not statistically significant.
The STI analyses similarly revealed no statistically significant association by circumcision status among MSM.
"Taken together, these findings indicate insufficient evidence among available observational studies conducted with MSM of an association between circumcision and HIV infection or other STIs," the researchers said.
"Additional studies are necessary to elucidate further the relationship between circumcision status and HIV infection or STIs among MSM," they added.
The study is published in the October 8 issue of JAMA.