Increased risk of HIV immediately following circumcision

Men who have undergone circumcision are at increased risk of infecting female partners with HIV immediately following surgery suggests research from the Johns Hopkins University and the Rakai Health Sciences Program in Uganda. Male circumcision is used as an HIV prevention method as it is known to reduce the of heterosexually acquired HIV infection in men by 60%.

The study, published in PLOS Medicine, suggests that circumcision may pose an HIV risk during the healing period of the wound, as there is a window period of a few weeks after circumcision during which there is an increased risk for men living with HIV to transmit the virus to a female partner during sexual intercourse. This is caused by the fact that men living with HIV are shedding the virus in greater amounts after circumcision than before. Viral Shedding is the term used for the process whereby the HIV virus becomes present in one of the bodily fluids capable of transmitting the virus.

The study conducted in Uganda included 223 HIV positive men who had been medically circumcised. Researchers found that among the 183 participants who did not take antiretroviral treatment, less than 10% were shedding the virus prior to the circumcision, compared to almost 30% two weeks after circumcision. As the circumcision wounds healed the percentage of men who were shedding dropped sharply to less than 3% after six weeks, and less than 2% after 12 weeks.

Male circumcision programmes counsel men to abstain from sex when their wounds are healing, although it is know that more than 30% have sex with a female partner during the healing period. For men taking antiretroviral treatment the risk of shedding the virus after circumcision is reduced by 90%. It is therefore advisable that HIV infected men start with antiretroviral treatment before circumcision. Future studies are needed need to indicate which treatment and for how long this needs to be taken to reduce the risk of HIV shedding.