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

Tanwei Yuan, Thomas Fitzpatrick, Nai-Ying Ko, Yong Cai, Yingqing Chen, Jin Zhao, Linghua Li, Junjie Xu, Jing Gu, Jinghua Li, Chun Hao, Zhengrong Yang, Weiping Cai, Chien Yu Cheng, Zhenzhou Luo, Kechun Zhang, Guohui Wu, Xiaojun Meng, Andrew E. Grulich, Yuantao HaoHuachun Zou

研究成果: Article

5 引文 (Scopus)

摘要

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 I 2 =77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I 2 =77%) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I 2 =40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I 2 =0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I 2 =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.

原文English
頁(從 - 到)e436-e447
期刊The Lancet Global Health
7
發行號4
DOIs
出版狀態Published - 2019 四月 1

指紋

Sexually Transmitted Diseases
Meta-Analysis
HIV
HIV Infections
Papillomavirus Infections
Simplexvirus
Observational Studies
China
Odds Ratio
Natural Science Disciplines
Male Circumcision
National Institutes of Health (U.S.)
Virus Diseases
PubMed
Libraries
Longitudinal Studies
Biomedical Research
Medicine
Technology
Health

All Science Journal Classification (ASJC) codes

  • Medicine(all)

引用此文

Yuan, Tanwei ; Fitzpatrick, Thomas ; Ko, Nai-Ying ; Cai, Yong ; Chen, Yingqing ; Zhao, Jin ; Li, Linghua ; Xu, Junjie ; Gu, Jing ; Li, Jinghua ; Hao, Chun ; Yang, Zhengrong ; Cai, Weiping ; Cheng, Chien Yu ; Luo, Zhenzhou ; Zhang, Kechun ; Wu, Guohui ; Meng, Xiaojun ; Grulich, Andrew E. ; Hao, Yuantao ; Zou, Huachun. / 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. 於: The Lancet Global Health. 2019 ; 卷 7, 編號 4. 頁 e436-e447.
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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",
abstract = "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 I 2 =77{\%}). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I 2 =77{\%}) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I 2 =40{\%}). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I 2 =0{\%}) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I 2 =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.",
author = "Tanwei Yuan and Thomas Fitzpatrick and Nai-Ying Ko and Yong Cai and Yingqing Chen and Jin Zhao and Linghua Li and Junjie Xu and Jing Gu and Jinghua Li and Chun Hao and Zhengrong Yang and Weiping Cai and Cheng, {Chien Yu} and Zhenzhou Luo and Kechun Zhang and Guohui Wu and Xiaojun Meng and Grulich, {Andrew E.} and Yuantao Hao and Huachun Zou",
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Yuan, T, Fitzpatrick, T, Ko, N-Y, Cai, Y, Chen, Y, Zhao, J, Li, L, Xu, J, Gu, J, Li, J, Hao, C, Yang, Z, Cai, W, Cheng, CY, Luo, Z, Zhang, K, Wu, G, Meng, X, Grulich, AE, Hao, Y & Zou, H 2019, '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, 卷 7, 編號 4, 頁 e436-e447. https://doi.org/10.1016/S2214-109X(18)30567-9

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. / Yuan, Tanwei; Fitzpatrick, Thomas; Ko, Nai-Ying; Cai, Yong; Chen, Yingqing; Zhao, Jin; Li, Linghua; Xu, Junjie; Gu, Jing; Li, Jinghua; Hao, Chun; Yang, Zhengrong; Cai, Weiping; Cheng, Chien Yu; Luo, Zhenzhou; Zhang, Kechun; Wu, Guohui; Meng, Xiaojun; Grulich, Andrew E.; Hao, Yuantao; Zou, Huachun.

於: The Lancet Global Health, 卷 7, 編號 4, 01.04.2019, p. e436-e447.

研究成果: Article

TY - JOUR

T1 - Circumcision to prevent HIV and other sexually transmitted infections in men who have sex with men

T2 - a systematic review and meta-analysis of global data

AU - Yuan, Tanwei

AU - Fitzpatrick, Thomas

AU - Ko, Nai-Ying

AU - Cai, Yong

AU - Chen, Yingqing

AU - Zhao, Jin

AU - Li, Linghua

AU - Xu, Junjie

AU - Gu, Jing

AU - Li, Jinghua

AU - Hao, Chun

AU - Yang, Zhengrong

AU - Cai, Weiping

AU - Cheng, Chien Yu

AU - Luo, Zhenzhou

AU - Zhang, Kechun

AU - Wu, Guohui

AU - Meng, Xiaojun

AU - Grulich, Andrew E.

AU - Hao, Yuantao

AU - Zou, Huachun

PY - 2019/4/1

Y1 - 2019/4/1

N2 - 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 I 2 =77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I 2 =77%) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I 2 =40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I 2 =0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I 2 =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.

AB - 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 I 2 =77%). Circumcision was protective against HIV infection among MSM in countries of low and middle income (0·58, 0·41–0·83; k=23; I 2 =77%) but not among MSM in high-income countries (0·99, 0·90–1·09; k=20; I 2 =40%). Circumcision was associated with reduced odds of herpes simplex virus (HSV) infection among MSM overall (0·84, 0·75–0·95; k=5; I 2 =0%) and penile human papillomavirus (HPV) infection among HIV-infected MSM (0·71, 0·51–0·99; k=3; I 2 =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.

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