Circumcision status at HIV infection is not associated with plasma viral load in men: analysis of specimens from a randomized controlled trial

Background Male circumcision provides men with approximately 60% protection from acquiring HIV infection via heterosexual sex, and has become a key component of HIV prevention efforts in sub-Saharan Africa. Possible mechanisms for this protection include removal of the inflammatory anaerobic sub-preputial environment and the high concentration of Langerhans cellson the inside of the foreskin, both believed to promote local vulnerability to HIV infection. In people who do acquire HIV, viral loadis partially determined by infecting partner viral load, potentially mediated by size of infecting inoculum. By removing a portal for virion entry, prior male circumcision could decrease infecting inoculum and thus viral loadin men who become HIV-infected, conferring the known associated benefits of slower progression to disease and decreased infectiousness.