Odoyo-June, E., Rogers, J., Jaoko, W., et al. Journal of Acquired Immune Deficiency Syndromes (December 2013), 64(5): 511–517.
This prospective cohort study, nested within a larger study, assessed whether medical male circumcision (MMC) of HIV-positive men who had never taken antiretroviral therapy (ART) leads to increased viral load and penile viral shedding. Increase in viral load or shedding may affect the transmissibility of HIV to partners. A total of 108 participants were evaluated at baseline and every week for six weeks or until wound healing was complete. Of these, 29 were evaluated for penile viral shedding, and HIV-1 RNA was measured in blood from 19 men and penile lavage samples from 29 men. For the 65 men who had not taken ART, mean CD4 count increased from baseline to two weeks; there was no change in the men (n=37) on ART. The study found no change in viral load. Penile viral shedding rose significantly by week one, but was undetectable by week six. The researchers found no detectable viral shedding after the MMC wound was fully healed in 96.6 percent (28 of 29) study participants. The authors concluded that MMC in men who have never taken ART leads to a temporary rise in penile viral shedding before complete wound healing. Programs should reinforce the importance of abstinence for six weeks after MMC to avoid higher risk of HIV transmission.