Circumcision May Reduce HIV Transmission

New cellular research suggests performing circumcision might help protect men -- and possibly their partners -- from contracting AIDS, researchers said. The research examined laboratory specimens of healthy human foreskin -- the covering of the penis that is removed in the operation, usually soon after birth -- and the specimens of cervical tissue from women undergoing surgery. They searched for CD4 T-cells, macrophages and Langerhan's cells, all of which are targets for HIV.

"We determined that the target cells that HIV infect are found in far greater numbers in the foreskin than in the cervix," said Dr. Carlos Estrada, a urologist at Rush-Presbyterian-St. Luke's Medical Center in Chicago. Estrada and colleagues presented a paper on their findings at the recent American Urological Association (AUA) annual meeting in Orlando, Fla. "Overall, the inner, mucosal surface of the foreskin had a seven-fold greater susceptibility to HIV infection than did cells in cervical tissue infected under the same conditions," Estrada said.

Estrada suggested reduced infection rates in men due to circumcision also should reduce HIV infections in women. "There has been a lot of controversy over whether circumcision prevents infection with HIV or is simply a marker of more rigorous religious practices," Estrada said. Circumcision is routinely practiced in the United States and is required for males by Jewish and Muslim religious laws. Several studies have shown in African nations where Islam is predominant, rates of HIV infection can be one-tenth that of nations where circumcision is not practiced or its practice has been abandoned -- as in some of the nations of southern Africa, where AIDS has reached epidemic proportions.

The new cellular research probably will not resolve the question. Dr. Thomas Brady, adjunct professor of urology at the University of Nevada-Reno, and chair of the media committee of the AUA, said. "I'm not sure that I buy this explanation that more cells in the foreskin increase the risk of transmission of HIV. Just because there are more cells doesn't mean that there is a greater transmission risk," he said. "I think it is far more logical to assume that during intercourse the penis suffers microabrasions and microscopic tears." In uncircumcised men, fluids that come in contact with the penis during intercourse can be trapped under the foreskin, which may make it easier for the virus to infect men through the organ's microscopic openings, Brady suggested.

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