Size Matters When it Comes to AIDS Defense

Male circumcision reduces female-to-male HIV transmission, and the current study examined whether the surface area of the foreskin is associated with HIV infection prior to circumcision.

In Uganda, researchers enrolled 965 HIV-negative men for male circumcision trials and measured the surface area of the foreskin after surgery. Prior to circumcision, the men provided researchers with 3,920.8 person-years of observation, and HIV incidence was calculated according to foreskin surface areas divided by quartiles.

The mean surface area of the foreskin was significantly larger among men who had acquired HIV prior to circumcision, compared with men who were not infected (43.3 square centimeters [standard error 2.1] vs. 36.8 square centimeters [standard error 0.5], P=0.01). In the lowest quartile (less than or equal to 26.3 square centimeters), HIV incidence was 0.80/100 person-years, compared with 0.92/100 person-years in the second quartile (26.4-35.0 square centimeters), 0.90/100 person-years in the third quartile (35.2-45.5 square centimeters), and 2.48/100 person-years in the highest quartile (more than 45.6 square centimeters).

Compared with men in the lowest quartile, the adjusted incidence rate ratio for HIV infection was 2.37 (95 percent confidence interval 1.05-5.31) in men with foreskin surface area within the largest quartile.

"The risk of male HIV acquisition is increased among men with larger foreskin surface areas," concluded Dr. Godfrey Kigozi of Johns Hopkins University's Rakai Health Sciences Program and colleagues.

The full report, "Foreskin Surface Area and HIV Acquisition in Rakai, Uganda (Size Matters)," was published in the journal AIDS (2009;23(16):2209-2213).

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