Our systematic review and meta-analysis was performed according to PRISMA and MOOSE guidelines. 13– 50 To inform global HIV and STI prevention strategies for MSM, we conducted an updated systematic review and meta-analysis on the association between circumcision and HIV and other STIs among MSM, stratifying important parameters. 11Ī large amount of new evidence has emerged, especially from LMICs, in the past decade. 10 A recent meta-analysis including 18 observational studies reported that circumcision was associated with 20% (95% confidence interval 0♶9-0♹2) reduced odds of HIV infection among MSM overall, however not among MSM who primarily engage in insertive anal sex. 9, 10 Significant protective associations between circumcision and HIV infection were identified in sub-analyses of studies conducted before the introduction of highly active antiretroviral therapy 1 and among MSM who primarily engage in insertive anal sex. 9, 10 Analyzing results from more than 20 observational studies, these meta-analyses found non-significant associations between circumcision and HIV infection and other STIs among MSM overall. 12 Two earlier systematic review and meta-analysis papers reported on the associations between circumcision and HIV infection and other STIs among MSM in 20. 9– 11 Existing male circumcision programmes primarily target heterosexual men and have not actively promoted circumcision among MSM. It remains unclear whether MSM similarly benefit from circumcision. 4– 6 The biological plausibility of circumcision to prevent HIV infection is also supported by immunohistological and histopathological studies that found a higher density of HIV target cells in the inner mucosa of the foreskin. Three randomized controlled trials (RCTs) conducted in Africa demonstrated that circumcision can reduce the risk of female-to-male transmission of HIV by 50% to 60%. The efficacy of male circumcision in preventing HIV among heterosexual men is well documented. 3 Evidence-based prevention approaches are urgently needed to optimize combination strategies to prevent HIV and other STIs among MSM. 2 Other sexually transmitted infections (STIs), including syphilis, herpes simplex virus (HSV), gonorrhea, chlamydia, and human papillomavirus (HPV), also disproportionately affect MSM and may increase risk of HIV infection. 2 Limited HIV prevention resources and entrenched stigma against MSM hamper access to HIV testing and treatment in LMICs. 2 MSM in low- and middle-income countries (LMICs) are particularly impacted. 1 Although HIV pre-exposure prophylaxis (PrEP), treatment of partners, and behavioural risk reduction are all effective in preventing HIV transmission among MSM, the HIV epidemic still contributes to substantial morbidity and mortality among MSM. Men who have sex with men (MSM) are disproportionately affected by HIV worldwide. School of Public Health (Shenzhen), Sun Yat-sen University, Shenzhen, China (T Yuan MD, Prof H Zou PhD) School of Medicine, University of Washington, Seattle, Washington, USA (T Fitzpatrick BA) Department of Nursing, National Cheng Kung University and Hospital, Tainan, Taiwan (Prof N Ko PhD) School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China (Prof Y Cai PhD) Vaccine and Infectious Disease Division and Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA (Prof Y Chen) Department of Biostatistics, University of Washington, Seattle, Washington, USA (Prof Y Chen) Shenzhen Center for Disease Control and Prevention, Shenzhen, China (J Zhao PhD, Z Yang PhD) Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China(L Li PhD, W Cai MD) Key Laboratory of AIDS Immunology of the National Health and Family Planning Commission, the First Affiliated Hospital, China Medical University, Shenyang, China (Prof J Xu PhD) School of Public Health, Sun Yat-sen University, Guangzhou, China (J Gu PhD, J Li PhD, Prof H Zou) Global Health Institute, Sun Yat-sen University, Guangzhou, China (J Gu PhD, C Hao PhD, J Li PhD, Prof Y Hao PhD, Prof H Zou PhD) Institute of State Governance, Sun Yat-sen University Guangzhou, China (J Gu PhD, C Hao PhD, J Li PhD, Prof Y Hao PhD) Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan (C Cheng MD) Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen, China (Z Luo MD) Shenzhen Longhua Center for Disease Control and Prevention, Shenzhen, China (K Zhang MD) Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China (G Wu MD) Wuxi Municipal Center for Disease Control and Prevention, Wuxi, China (X Meng MD) and Kirby Institute, the University of New South Wales, Sydney, Australia (Prof H Zou, Prof A Grulich)
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |