(Press-News.org) The likelihood of viral shedding from male circumcision wounds intially increases, then decreases as the wounds heal, and is lower in patients with lower plasma viral load, according to a study published this week in PLOS Medicine. The study, conducted by Aaron Tobian, of Johns Hopkins University, Baltimore, MD and the Rakai Health Sciences Program, Entebbe, Uganda, and colleagues, monitored 223 HIV-infected men for wound healing and viral shedding from their surgical wounds for 12 weeks following voluntary medical male circumcision.
The researchers found that, compared to specimens obtained from washings of the surgical site before circumcision, HIV viral shedding in the area of the surgical site was more common in weeks 1, 2, and 3 after surgery, (by 87%, 216% and 98% of men, respectively). However, by six weeks after surgery, all wounds had healed and viral shedding decreased. Compared to baseline, shedding was detected in 73% and 81% fewer men at weeks 6 and 12 after surgery, respectively. Overall, they found that viral shedding from the surgical site was 88% less common in visits from men with healed surgical wounds compared to men whose wounds were still healing.
In addition to wound healing, lower amounts of virus in the blood was also associated with less viral shedding. At enrollment, 40 men reported being on antiretroviral treatment (ART), 29 of whom had undetectable plasma viral load. HIV shedding was more 10 times less likely in men with low or undetectable plasma viral load (50,000 copies/ml), and when virus was detected in washings from the wounds of men with ART-suppressed viral loads, it was at lower levels than in men not on ART.
The authors say:
"The findings from this study reinforce the need for male circumcision programs to provide voluntary HIV counseling and testing prior to MC, promote sexual abstinence during wound healing and condom use thereafter, offer free condoms, and encourage counseling for HIV-infected men and their sexual partners on the risk of HIV transmission if sexual intercourse is resumed prior to complete wound healing."
INFORMATION:
Research Article
Funding: This study was supported by the Bill & Melinda Gates Foundation (22006.03, sample collection), the Doris Duke Charitable Foundation (#2011036, laboratory work), the Division of Intramural Research, National Institute of Allergy and Infectious Diseases and the Fogarty International Center, 1D43TWOO9578-01. AART was supported by the NIH 1K23AI093152-01A1 and the Doris Duke Charitable Foundation Clinician Scientist Development Award. MKG was supported by NIH T32AI102 and the Doris Duke Charitable Foundation Clinician Scientist Development Award. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
Competing Interests: JL is a member of the Editorial Board of PLOS Medicine. All other authors have declared that no competing interests exist.
Citation: Tobian AAR, Kigozi G, Manucci J, Grabowski MK, Serwadda D, et al. (2015) HIV Shedding from Male Circumcision Wounds in HIV-Infected Men: A Prospective Cohort Study. PLoS Med 12(4): e1001820. doi:10.1371/journal.pmed.1001820
Author Affiliations:
Department of Pathology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America;
Rakai Health Sciences Program, Entebbe, Uganda;
Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America;
Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America;
Institute of Public Health, Makerere University, Kampala, Uganda;
Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America;
Contact:
Aaron A. R. Tobian
Johns Hopkins University
atobian1@jhmi.edu
Data from southeast Asia -- where artemisinin-resistant malaria strains were first detected -- broadly support WHO's 'working definition' for artemisinin resistance, but the currently used definitions require important refinements, according to a study by Lisa White and colleagues, from Mahidol University in Bangkok, Thailand, published this week in PLOS Medicine.
The drug artemisinin rapidly clears malaria parasites from the blood of infected patients -- unless the parasites have developed resistance, in which case parasite clearance after artemisinin therapy (ACT) takes ...
A new study from Loyola University Medical Center provides further evidence that female infants tend to do better than males when born prematurely.
The study found that female infants independently orally fed one day earlier than males. The ability to suck, swallow and breathe simultaneously are reflexes that many premature infants are unable to do. Learning to master these skills and eat independently without feeding tubes is necessary before an infant can safely go home from the hospital.
Researchers set out to determine the mean age when premature infants are able ...
Lucy and other members of the early hominid species Australopithecus afarensis probably were similar to humans in the size difference between males and females, according to researchers from Penn State and Kent State University.
"Previous convention in the field was that there were high levels of dimorphism in the Australopithecus afarensis population," said Philip Reno, assistant professor of anthropology, Penn State. "Males were thought to be much larger than females."
Sexual dimorphism refers to differences between males and females of a species. These can show up, ...
A new University of Colorado Boulder study involving some 40,000 people indicates that social and psychological problems caused by drinking generally trump physically hazardous drinking behaviors when it comes to overall mortality rates.
The study showed, for instance, that participants who had experienced an intervention by physicians, family members or friends had a 67 percent greater risk of death over the 18-year study period, said sociology Professor Richard Rogers, lead study author. Those who reported cutting down on social or sports activities because of alcohol ...
When educating medical students or residents to perform highly technical procedures, there is always a challenge to balance the educational mission with maintaining quality results and optimal patient care. This report compared outcomes of cardiac surgery residents to those of attending physicians in performing coronary artery bypass grafting. It found no differences in patient outcomes or graft patency between the residents and attending surgeons.
Seattle WA, April 28, 2015 - A conundrum in medical education is how to train residents in complex and technically difficult ...
Over the last 15 years, survival of children with congenital heart disease (CHD) has greatly improved, so that currently there are more adults than children living with CHD. Consequently, people with CHD of all ages are undergoing pulmonary valve replacement (PVR) with bioprosthetic valves. In this retrospective review of all patients with CHD who underwent bioprosthetic PVR over an 18-year period at Boston Children's Hospital, investigators found that young age and small body weight predisposed patients toward re-intervention, as did the type of valve used.
Seattle, ...
Boston, Mass (April 27, 2015) -- In a recent issue of Science Translational Medicine, Brian Polizzotti, PhD, Bernhard Kuhn, MD, Sangita Choudhury, PhD, and colleagues affiliated with the Boston Children's Hospital's Translational Research Center report that the optimal window of time to stimulate heart muscle cell regeneration (cardiomyocyte proliferation) in humans is the first six months of life.
"Our results suggest that early administration of neuregulin may provide a targeted and multipronged approach to prevent heart failure in infants with CHD. Beginning treatment ...
Humans and cattle share a similar epigenetic fetal overgrowth disorder that occurs more commonly following assisted reproduction procedures. In humans, this disorder is called Beckwith-Wiedemann syndrome (BWS), and in cattle it is called large offspring syndrome (LOS) and can result in the overgrowth of fetuses and enlarged babies. This naturally occurring, but rare syndrome can cause physical abnormalities in humans and cattle and often results in the deaths of newborn calves and birth-related injuries to their mothers.
Now, researchers at the University of Missouri ...
CHESTER, Calif. - A study just published this week shows many bird species, including several of high conservation concern, aren't getting the habitat they need due to a focus on promoting California Spotted Owl habitat in the northern Sierra Nevada.
The study, published in the science journal, PLoS ONE, tracked different bird species' use of areas inside and outside Spotted Owl reserves for two years in Plumas and Lassen National Forests. The results show 17 species avoided the reserves, including species of conservation concern like Yellow Warblers and Olive-sided ...
New Haven, Conn. -- Yale researchers conducted the first known randomized trial comparing three treatment strategies for opioid-dependent patients receiving emergency care. They found that patients given the medication buprenorphine were more likely to engage in addiction treatment and reduce their illicit opioid use.
Dependence on prescription and illicit opioids is an epidemic that continues to grow in the United States and globally. Drug overdoses account for more deaths each day than car crashes. "This is a huge public health problem," said first author Dr. Gail D'Onofrio, ...
