Abstract [excerpts]

Objective: Determine whether male circumcision would be effective in reducing HIV transmission among men who have sex with men (MSM).

Design: Retrospective analysis of the VAXGen VAX004 HIV vaccine clinical trial data.

Methods: Survival analysis was used to associate time to HIV infection with multiple predictors. Unprotected insertive and receptive anal sex predictors were highly correlated, thus separate models were run.

Results: Four thousand eight hundred and eighty-nine participants were included in this reanalysis; 86.1% were circumcised. Three hundred and forty-two (7.0%) men became infected during the study; 87.4% were circumcised. Controlling for demographic characteristics and risk behaviors, in the model that included unprotected insertive anal sex, being uncircumcised was not associated with incident HIV infection ... Furthermore, while having unprotected insertive ... or receptive ... anal sex with an HIV-positive partner were associated with HIV infection, the associations between HIV incidence and the interaction between being uncircumcised and reporting unprotected insertive ... or receptive ... anal sex with an HIV-positive partner were not statistically significant. ...

Conclusions: Among men who reported unprotected insertive anal sex with HIV-positive partners, being uncircumcised did not confer a statistically significant increase in HIV infection risk. Additional studies with more incident HIV infections or that include a larger proportion of uncircumcised men may provide a more definitive result.

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