Male circumcision poses HIV risk to women

[InnerBrat]

This will expire

Policy-makers must exercise caution when including male circumcision among their tactics for fighting AIDS, researchers said on Tuesday. Early data from a trial in Uganda suggests the practice could increase infections in women.

In 2006, three groundbreaking studies conducted in Africa found that male circumcision halved a man's risk of being infected with HIV (see Male circumcision: a contentious cut). That discovery raised hope that the war against AIDS could be transformed by a simple, low-cost operation.

The new trial, funded by the Bill and Melinda Gates Foundation, explores a different angle – to see if circumcised men who are infected with HIV are any less likely to infect their female partner. US and Ugandan researchers are following almost 2000 HIV-infected men in Rakai, Uganda. Some of them have been circumcised, while the others have remained uncircumcised to act as a comparison.

A proportion of volunteers in both groups had uninfected long-term female partners at the start of the study. These women were also enrolled and monitored. A review at the study's six-month mark looked at 70 couples in the circumcised group and found that 11 of the women had become infected (16%). Among 54 couples in the "uncircumcised" group, four women had become infected (7%).

Time to heal

The study is ongoing and the data is not considered conclusive but the researchers say they are concerned. They believe several of the infections had been transmitted by men who had had sex before their wounds had fully healed from the circumcision surgery. HIV can be carried in both blood and semen.

If the increase in partner infection after circumcision is confirmed, it would mean it could not be endorsed as a prevention strategy without ensuring men and women are fully aware of the need to refrain from intercourse for a month or so until the penile wound has healed, the researchers said.

Volunteers in the Rakai study were repeatedly given safe-sex counselling and provided with free condoms. Women who become infected have been promised access to free HIV care and antiretroviral drugs.

Weighing the data

"We need to err on the side of caution to protect women in the context of any future male circumcision programme," said the study's lead scientist, Maria Wawer, at the Johns Hopkins Bloomberg School of Public Health in Baltimore, Maryland, US.

The data was released on Tuesday as a contribution to a meeting of the World Health Organization and UNAIDS in Montreux, Switzerland. The two agencies are mulling the outcome of the three big trials to weigh how far, and how fast, they should endorse circumcision as a prevention policy.

The WHO's Kevin De Cock stressed the need for caution and good preparations: "While male circumcision has extraordinary potential to prevent HIV infection, these new findings remind us that we must proceed with thought and care in developing male circumcision in Africa."

All this really seems to mean is that the rising trend of circumcising men in order to protect them is probably a bit dumb, and that having sex when you're HIV+ and your knob is bleeding is probably even dumber.

There are a number of parts I'm interested in - what's the point in circumcising for protection if he's already infected? I couldn't read the previous linked article to see whether circumcision was meant to prevent infection or spreading previously existing infection.

And then, the ethics of the study makes me twitch a little, even though the data is probably good. Does anyone else get that reaction?

Also: de Cock is a fantastic name.

[Darth Wong]

Having a guy named "de Cock" speaking about male circumcision is just too funny for words.

But really, circumcision cannot be even vaguely compared to condoms as a prevention mechanism, and I get the impression that the push to classify circumcision as an AIDS-fighting measure is nothing more than pro-circumcision forces looking for a new angle (hence it's not really about AIDS at all; it's about circumcision).

[InnerBrat]

Yep. Pretty much my interpretation of any research into the topic.

That and I expect AIDS workers are pretty much desperate at this stage for anything that has an effect. So they'll jump on any statistical blip to get published.

Still, I'd like to know if there is something in this one in particular - something beyond "don't have unprotected sex with a bleeding knob", I mean.

[Cairber]

*Insert cairber's typical rant about circumcision*


In addition to the above study, we now also have this study:

Langerhans cells PROTECT against HIV

Langerhans cells, plentiful in the foreskin, are the ones that the scientists in the circ protects against HIV study said are what makes the skin transmitt HIV more effectively.


So, in conclusion, I have said the words "I TOLD YOU SO" many times this week. BUt, with parents, we are just trying to get the word out that this HIV thing is not a good reason for genital cutting.

(shameless plug: the march for genital integrity is at the end of the month if anyone is in the washington, DC area. I will be there! I will be the one in the Tshirt with Yoda on it "May the Foreskin Be With You") [/url]

[Cairber]

hmm that link didnt work

well here's the story:

MONDAY, March 5 (HealthDay News) -- Researchers have discovered that cells in the mucosal lining of human genitalia produce a protein that "eats up" invading
HIV -- possibly keeping the spread of the
AIDS more contained than it might otherwise be.
ADVERTISEMENT

Even more important, enhancing the activity of this protein, called Langerin, could be a potent new way to curtail the transmission of the virus that causes AIDS, the Dutch scientists added.

Langerin is produced by Langerhans cells, which form a web-like network in skin and mucosa. This network is one of the first structures HIV confronts as it attempts to infect its host.

However, "we observed that Langerin is able to scavenge viruses from the surrounding environment, thereby preventing infection," said lead researcher Teunis Geijtenbeek, an immunologist researcher at Vrije University Medical Center in Amsterdam.

"And since generally all tissues on the outside of our bodies have Langerhans cells, we think that the human body is equipped with an antiviral defense mechanism, destroying incoming viruses," Geijtenbeek said.

The finding, reported in the March 4 online issue of Nature Medicine, "is very interesting and unexpected," said Dr. Jeffrey Laurence, director of the Laboratory for AIDS Virus Research at the Weill Cornell Medical College, in New York City. "It may explain part of the relative inefficiency of HIV in being transmitted."

Even though HIV has killed an estimated 22 million people since it was first recognized more than 25 years ago, it is actually not very good at infecting humans, relatively speaking.

For example, the human papillomavirus (HPV), which causes cervical cancer, is nearly 100 percent infectious, Laurence noted. That means that every encounter with the sexually transmitted virus will end in infection.

"On the other hand, during one episode of penile-vaginal intercourse with an HIV-infected partner, the chance that you are going to get HIV is somewhere between one in 100 and one in 200," Laurence said.

Experts have long puzzled why HIV is relatively tough to contract, compared to other pathogens. The Dutch study, conducted in the laboratory using Langerhans cells from 13 human donors, may explain why.

When HIV comes in contact with genital mucosa, its ultimate target -- the cells it seeks to hijack and destroy -- are immune system T-cells. But T-cells are relatively far away (in lymph tissues), so HIV uses nearby Langerhans cells as "vehicles" to migrate to T-cells.

For decades, the common wisdom was that HIV easily enters and infects Langerhans cells. Geijtenbeek's team has now cast doubt on that notion.

Looking closely at the interaction of HIV and Langerhans cells, they found that the cells "do not become infected by HIV-1, because the cells have the protein Langerin on their cell surface," Geijtenbeek said. "Langerin captures HIV-1 very efficiently, and this Langerin-bound HIV-1 is taken up (a bit like eating) by the Langerhans cells and destroyed."

In essence, Geijtenbeek said, "Langerhans cells act more like a virus vacuum cleaner."

Only in certain circumstances -- such as when levels of invading HIV are very high, or if Langerin activity is particularly weak -- are Langerhans cells overwhelmed by the virus and infected.

The finding is exciting for many reasons, not the least of which is its potential for HIV prevention, Geijtenbeek said.

"We are currently investigating whether we can enhance Langerin function by increasing the amount of Langerin on the cell surface of Langerhans cells," he said. "This might be a real possibility, but it will take time. I am also confident that other researchers will now also start exploring this possibility."

The discovery might also help explain differences in vulnerability to HIV infection among people.

"It is known that the Langerin gene is different in some individuals," Geijtenbeek noted. "These differences could affect the function of Langerin. Thus, Langerhans cells with a less functional Langerin might be more susceptible to HIV-1, and these individuals are more prone to infection. We are currently investigating this."

The finding should also impact the race to find topical microbicides that might protect women against HIV infection. Choosing compounds that allow Langerin to continue to work its magic will enhance any candidate microbicide's effectiveness, the Dutch researcher said.

Laurence did offer one note of caution, however.

"In the test tube, this is a very important finding," he said. "But there are many things in the test tube that don't occur when you get into an animal or a human. Having said that, though, this is a very intriguing finding."

[Trytostaydead]

The title is a bit misleading given the context and data of the new research. Wong is right, circumcision is nowhere near the effectiveness of say a condom is. But whatever percentage or odds that works in their favor right now in Africa is probably a good thing. Though given Africa's lack of education/knowledge and possibly self-restraint, unless men are getting circumcised before they have urges, then the new data will hold true unfortunately.

[Lord Zentei]

The title is a bit misleading given the context and data of the new research. Wong is right, circumcision is nowhere near the effectiveness of say a condom is. But whatever percentage or odds that works in their favor right now in Africa is probably a good thing. Though given Africa's lack of education/knowledge and possibly self-restraint, unless men are getting circumcised before they have urges, then the new data will hold true unfortunately.

Did you check out Cairber's article?

[Cairber]

Though given Africa's lack of education/knowledge and possibly self-restraint, unless men are getting circumcised before they have urges, then the new data will hold true unfortunately.

The thing about them using these studies to promote circumcision in infants/children is that all signs point to a vaccine in 10 years. We are making strides every day. It seems foolish and a waste of money to implement large scale circumcision of nonsexually active males when chances are, by the time they are 10-12 years old, we will have a better defense than "cut a piece off."

If you stick with circumcising sexually active and those thinking about it, you run into the problem found in this study (note we don't have the full results. There are two studies looking at this, for all we know it could come back that circumcised males increase infection through intercourse even after the healing period).

Uganda's president reported a few weeks ago that the notion that circumcision is a "vaccine" and the misinterpretation of the protection circumcision may give has lead to more risky sexual behavior.

[Trytostaydead]

The title is a bit misleading given the context and data of the new research. Wong is right, circumcision is nowhere near the effectiveness of say a condom is. But whatever percentage or odds that works in their favor right now in Africa is probably a good thing. Though given Africa's lack of education/knowledge and possibly self-restraint, unless men are getting circumcised before they have urges, then the new data will hold true unfortunately.

Did you check out Cairber's article?

I did, how does that pertain though to the OP and what I just said?

While I have hope it will do some good, as the researcher pointed out, finding something out in the test tube and implementing it to the body can be more than just a little tricky. We know of tons of things that mess with HIV, and some of them almost confer a type of immunity. But still, no silver bullet.