How Does Voluntary Medical Male Circumcision Reduce HIV Risk?

Authors

Jessica L. Prodger, Departments of Microbiology and Immunology and Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, N6A 5C1, Canada.
Ronald M. Galiwango, Rakai Health Sciences Program, Kalisizo, Uganda.
Aaron A. Tobian, Department of Pathology, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, MD, 21205, USA.
Daniel Park, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Cindy M. Liu, Department of Environmental and Occupational Health, Milken Institute School of Public Health, George Washington University, Washington, DC, 20052, USA.
Rupert Kaul, Departments of Medicine and Immunology, University of Toronto, Medical Sciences Building Rm. 6356, 1 King's College Circle, Toronto, ON, M5S 1A8, Canada. rupert.kaul@utoronto.ca.

Document Type

Journal Article

Publication Date

12-1-2022

Journal

Current HIV/AIDS reports

Volume

19

Issue

6

DOI

10.1007/s11904-022-00634-w

Keywords

HIV susceptibility; Microbiome; Mucosal immunology; Penile circumcision

Abstract

PURPOSE OF REVIEW: Voluntary medical male circumcision (VMMC) is a surgical procedure that reduces HIV acquisition risk by almost two-thirds. However, global implementation is lagging, in part due to VMMC hesitancy. A better understanding of the mechanism(s) by which this procedure protects against HIV may increase acceptance of VMMC as an HIV risk reduction approach among health care providers and their clients. RECENT FINDINGS: HIV acquisition in the uncircumcised penis occurs preferentially across the inner foreskin tissues, due to increased susceptibility that is linked to elevated inflammatory cytokine levels in the sub-preputial space and an increased tissue density of HIV-susceptible CD4 + T cells. Inflammation can be caused by sexually transmitted infections, but is more commonly induced by specific anaerobic components of the penile microbiome. Circumcision protects by both directly removing the susceptible tissues of the inner foreskin, and by inducing a less inflammatory residual penile microbiome. VMMC reduces HIV susceptibility by removing susceptible penile tissues, and also through impacts on the penile immune and microbial milieu. Understanding these mechanisms may not only increase VMMC acceptability and reinvigorate global VMMC programs, but may also lead to non-surgical HIV prevention approaches focused on penile immunology and/or microbiota.

APA Citation

Prodger, Jessica L.; Galiwango, Ronald M.; Tobian, Aaron A.; Park, Daniel; Liu, Cindy M.; and Kaul, Rupert, "How Does Voluntary Medical Male Circumcision Reduce HIV Risk?" (2022). GW Authored Works. Paper 2187.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2187

Department

Environmental and Occupational Health