The largest investments in AIDS prevention targeted to the general population are being made in interventions where the evidence for large-scale impact is uncertain.

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Reassessing HIV Prevention

"Know your epidemic, know your response": a useful approach, if we get it right.

Background 
Three randomized controlled trials (RCTs) have confirmed that male circumcision (MC) significantly reduces acquisition of HIV-1 infection among men The objective of this study was to perform a comprehensive, prospective evaluation of risk compensation, comparing circumcised versus uncircumcised controls in a sample of RCT participants


Methods and Findings 
Between March 2004 and September 2005, we systematically recruited men enrolled in a RCT of MC in Kenya Detailed sexual histories were taken using a modified Timeline Followback approach at baseline, 6, and 12 months Participants provided permission to obtain circumcision status and laboratory results from the RCT We evaluated circumcised and uncircumcised men's sexual behavior using an 18-item risk propensity score and acquisition of incident infections of gonorrhea, chlamydia, and trichomoniasis Of 1780 eligible RCT participants, 1319 enrolled (response rate = 74%) At the baseline RCT visit, men who enrolled in the sub-study reported the same sexual behaviors as men who did not We found a significant reduction in sexual risk behavior among both circumcised and uncircumcised men from baseline to 6 (p<001) and 12 (p = 005) months post-enrollment Longitudinal analyses indicated no statistically significant differences between sexual risk propensity scores or in incident infections of gonorrhea, chlamydia, and trichomoniasis between circumcised and uncircumcised men These results are based on the most comprehensive analysis of risk compensation yet done


Conclusion 
In the context of a RCT, circumcision did not result in increased HIV risk behavior Continued monitoring and evaluation of risk compensation associated with circumcision is needed as evidence supporting its' efficacy is disseminated and MC is widely promoted for HIV prevention

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Risk compensation is not associated with male circumcision in Kisumu Kenya: A multi-faceted assessment of men enrolled in a randomized controlled trial.

Male circumcision and risk of HIV-1 and other sexually transmitted infections in India

Chronic human immunodeficiency virus (HIV) infection, separately and in combination with highly active antiretroviral therapy (HAART) is closely associated with oxidative stress (OS). Most studies demonstrating redox imbalances in HIV-infected individuals have done so using conventional biochemical methodologies. The limited simultaneous detection of multiple OS markers within one sample is a major drawback of these methodologies and can be addressed through the use of metabonomics. HIV-metabonomic studies utilizing biofluids from HAART cohorts as the investigative source, are on the increase. Data from many of these studies identified metabolic markers indicative of HIV-induced OS, usually as an outcome of an untargeted metabonomics study. Untargeted studies cast a wide net for any and all detectable metabolites in complex mixtures. Given the prevalence of OS during HIV infection and antiviral treatment, it is perhaps not surprising that indicators of this malady would become evident during metabolite identification. At times, targeted studies for specific (non-OS) metabolites would also yield OS markers as an outcome. This review examines the findings of these studies by first providing the necessary background information on OS and the main ways in which free radicals/reactive oxygen species (ROS) produced during OS, cause biomolecular damage. This is followed by information on the biomarkers which come about as a result of free radical damage and the techniques used for assaying these stress indicators. The established links between elevated ROS and lowered antioxidants during HIV infection and the subsequent use of HAART is then presented followed by a review of the OS markers detected in HIV metabonomic studies to date. We identify gaps in HIV/HAART-associated OS research and finally suggest how these research gaps can be addressed through metabonomic analysis, specifically targeting the multiple markers of HIV-induced OS.

HIV/HAART-associated oxidative stress is detectable by metabonomics

What would the reaction of the international public health community have been if a year ago scientists had announced the discovery of a vaccine or chemical gel that, in three separate clinical trials, had reduced the risk of heterosexual HIV infection in men by at least 60%? Considering that even with increasing access to antiretroviral therapy AIDS continues to be a huge killer – every day over 2,000 men become infected with HIV in sub-Saharan Africa alone [1], which eventually also results in millions of new cases in their partners and children – would not such an announcement have surely sparked a massive surge of excitement and renewed investment in HIV prevention?

Kawango Agot

Papers

Is male circumcision as good as the HIV vaccine we’ve been waiting for?