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Circuncisión para la prevención del VIH en hombres que tienen relaciones sexuales con hombres: un metaanálisis

Stephanie M Davis¹, Ian Fellows¹, Oscar de Leon¹

¹Division of Global HIV and Tuberculosis, U.S. Centers for Disease Control and Prevention 1600 Clifton Rd NE, Atlanta 30333, USA.

Journal of acquired immune deficiency syndromes (1999)

|February 23, 2026

Abstracto

Background:

Circumcision reduces HIV risk for men who have sex with women, but for men who have sex with men (MSM), prior meta-analyses were ambiguous due to inconsistent, highly-confounded data suggesting regional differences. This has left the weight of evidence unclear even after a small 2024 trial in PI-MSM in China showed protection. Any protection would be for primarily-insertive MSM (PI-MSM) and could have substantial impact given high incidence.

Setting:

No restrictions.

Methods:

We performed an updated literature search on the association of male circumcision with HIV among MSM. We conducted descriptive analyses, and a random-effects meta-analysis among PI-MSM. To isolate the protective effect of circumcision from confounders, we then performed a confounder-adjusted meta-analysis, comparing the effect of circumcision on HIV status among PI-MSM versus other MSM, testing for publication bias (funnel plot asymmetry) and regional heterogeneity (United States//Canada/Europe/Australia vs. Asia/Africa/Latin America).

Results:

Forty-nine studies were included in the descriptive analysis, 13 in the unadjusted meta-analysis, and 10 in the confounder-adjusted meta-analysis. In the unadjusted meta-analysis, circumcision was associated with a lower HIV risk among PI-MSM (odds ratio (OR) = 0.57, 95% CI: 0.33-0.98); publication bias and heterogeneity were present. In the confounder-adjusted analysis, the additional effect of circumcision in the PI-MSM group - a ratio of ORs - was 0.53 (95% CI: 0.34-0.83), a significant, substantial protective effect. Regional heterogeneity (p=0.65) and publication bias (p=0.34) were not present.

Conclusions:

Among PI-MSM, circumcision was protective against HIV. Findings support male circumcision as an effective HIV prevention method for PI-MSM.

Palabras clave:

prevención del VIH HSH (hombres que tienen relaciones sexuales con hombres)circuncisión sexo insertivo

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