The study was conducted by the Indiana University and has painted a scary picture of the claim of HIV prevention.
A study has shown that circumcised men in the Mpumalanga province have a higher rate of HIV than those who are not circumcised.
The findings appear to suggest that it needs to be communicated to both men and women that circumcision does not offer 100% protection against HIV, according to reports.
Published in the PLOS ONE journal this month, it surveyed over 2 300 men across the province who were 40 years and older.
It was conducted by professors from the Indiana and Wits Universities.
One of the professors Molly Rosenberg and Till Barnighausen say it is important to note that circumcision still works to reduce the risk of contracting HIV – with over 27 studies have proved this.
But in this latest study, the result has showed the opposite.
Men who reported being circumcised in hospital through voluntary medical male circumcision when older had an HIV prevalence rate of 31%, meaning that almost one in three men were positive.
There are three possible theories for the counterintuitive finding, Rosenberg and Barnighausen explained.
The first of their three theories is that HIV positive men are opting for circumcision at higher rates.
This may be because they may already be going to clinics and getting antiretrovirals, and then make use of other services available at the clinic.
The second theory is that men who are at higher risk of contracting HIV because they have many sexual partners or do not like using condoms, opt for circumcision because they think it is a safe solution.
However, they then still get HIV from unprotected sex.
It could also be, still in accordance with the second theory, that men engage in riskier sexual behaviour after circumcision because they know they are at a decreased risk.
But the researchers say the second theory is probably the least likely explanation because multiple studies have showed no evidence for this kind of risk compensation after medical male circumcision.
Deputy director of the Wits Reproductive Health and HIV Institute, said if men are taking greater sexual risks after circumcision, communication about it needs to change.
“This well-conducted study should make us carefully look at our messaging around circumcision, so that we don’t lose some of the impact of this effective intervention,” professor Francois Venter from Wits said.
And the third theory is that HIV-positive men are more likely to get circumcised. The study says government policy that HIV-negative men must get circumcised and awareness about its protective effects “gives the false impression that circumcised men are safer sex partners”.
“If HIV-positive men actually take up the circumcision procedure at high rates … [and are seen by women as safer], it may have the unintended consequence of increasing HIV transmission,” reads the statement of the finding.
The study also found that uncircumcised men 40 years and older in Mpumalanga showed an HIV prevalence rate of 24% – which means that 1 in 4 men above 40 was HIV positive.
Those circumcised through initiation while they were young, had a prevalence of 16%, showing that getting circumcised younger really does reduce the risk of HIV.
The researchers wrote: “In our study population of over 2,000 men, only a quarter reported being circumcised, which is actually lower than the national estimate of circumcision rates. So any social desirability bias potentially distorting our findings is unlikely to be very large.
“We strongly support universal circumcision of all HIV-men in SA, because it is known with certainty that circumcision biologically protects against HIV-based on three large well-conducted randomised controlled trials.”
The study of 9 763 people with HIV in South Africa and the USA showed that individuals with the specific HLA type progress from asymptomatic HIV infection to becoming ill with Aids faster.
A study published in the prestigious journal Science sheds new light on how specific human genes can lead to the faster progression of Aids-related illness in people living with HIV who are not on treatment. South African scientists led the international research team that discovered that a specific-type Human Leucocyte Antigen (HLA) gene complex helps HIV infected cells to escape the body’s first line of defence, an immune cell known as natural killer (NK) cells.
The study of 9 763 people with HIV in South Africa and the USA showed that individuals with the specific HLA type progress from asymptomatic HIV infection to becoming ill with Aids faster. In these individuals, their viral load (number of viruses in their blood) was higher and their CD4 immune cells were destroyed more rapidly, before they started antiretroviral treatment. It is estimated that about 2 million of the approximately 7 million people living with HIV in South Africa have this specific HLA type.
UKZN research team co-leader Dr Veron Ramsuran. Pic MSF.
The research team comprised scientists from the KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), the Centre for the AIDS Programme of Research in South Africa (CAPRISA) and the Human Pathogenesis Programme (HPP) – all based at the University of KwaZulu-Natal (UKZN) – together with researchers from the US National Institutes of Health, the Ragon Institute as well as researchers from Harvard, Oxford, Vanderbilt, Northwestern and Stanford Universities, Icahn School of Medicine at Mount Sinai, École Polytechnique Fédérale de Lausanne, MIT, Walter Reed Army Institute of Research, University of California – San Francisco, San Francisco Department of Health, and Microsoft.
This work is a culmination of five years of research, which included post-doctoral studies by Dr Ramsuran, with Dr Mary Carrington at FNCLR. Dr Ramsuran is a South African scientist currently at KRISP in the College of Health Sciences, UKZN and is a Research Associate at CAPRISA. Dr Naranbhai is a South African physician and scientist currently at Harvard University and is affiliated with Oxford University, the Ragon Institute and CAPRISA.
Besides studying HLA in almost 10 000 people, the team conducted additional laboratory experiments with cells in test-tubes, including those assessing HIV infectivity. These experiments confirmed the specific HLA-A expression had a direct effect on NK cells and that blocking the interaction between HLA and NK cells with certain drugs reverses this effect.
“I was pleasantly surprised by the findings, as I expected the opposite results since the HLA genes were thought to protect against viruses,” said Dr Veron Ramsuran, co-leader of the study who is a scientist at KRISP and CAPRISA at the University of KwaZulu-Natal. “The human genome contains genes that help to guard the body against bacteria or viruses. We have now shown a potential detrimental effect of specific HLA types in people living with HIV who are not on treatment. Further, we now understand that this is due to the interaction between HLA-A expression and NK cells.”
“This study demonstrates how, by doing locally responsive investigation as a team at the highest level can lead to new insights. This is the largest genetic study in HIV thus far. Moreover, these findings are exciting because drugs to target the HLA interaction with immune cells are being developed for cancer but may be repurposed for HIV treatment and cure strategies,” said Dr Vivek Naranbhai, a co-leader of the study based at Harvard University.
“The HLA genes are highly variable across humans and the impact of this variation on how well a given individual infected with HIV can control the virus is very significant, but complex,” said Dr Mary Carrington, Director of the Basic Science Program at FNLCR. “Our results show that expression levels of these genes contribute to the overall effect of HLA variation on HIV control through the innate, as well as the adaptive immune response. Now we must carefully consider how to use this information for the benefit of patients with HIV.”
“These results open a new door to understanding why some people become sick with Aids so soon after acquiring HIV infection,” says Professor Salim S Abdool Karim, Director of CAPRISA and Pro Vice-Chancellor (Research) at the University of KwaZulu-Natal. “The study’s findings highlight the importance of regular HIV testing, so that people with HIV can get to know their status and start antiretroviral treatment early, well before they become ill with Aids.”
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