On 2014 Dec 22, James G Thornton commented:

I appreciate that this review is about the effect of male circumcision on heterosexual acquisition of HIV in men, but the effect on the risk of female acquisition of HIV is surely relevant, and since there is no Cochrane review of that, I am commenting here.

The only randomised trial (Wawer et al 2009) showed 17/93 (18%) HIV acquisition in male circumcision female partners v 8/70 (11%) in control female partners. The difference might have occurred by chance (hazard ratio 1.58, 95% CI: 0.68–3.66, p=0.287), but the point estimate is almost exactly the same size harmful effect as the beneficial effect in men. Unfortunately the trial was stopped early for futility because the conditional power to detect 60% efficacy, was only 4.9%.

The trial authors have never adequately explained why stopping for futility was appropriate, given that the evidence in men was regarded as sufficient to encourage male circumcision.

Can I suggest that until there is a separate Cochrane review for the effect on women, that the outcome "heterosexual acquisition of HIV in female partners" be included in this review?

Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229-37.

On 2014 Dec 22, James G Thornton commented:

I appreciate that this review is about the effect of male circumcision on heterosexual acquisition of HIV in men, but the effect on the risk of female acquisition of HIV is surely relevant, and since there is no Cochrane review of that, I am commenting here.

The only randomised trial (Wawer et al 2009) showed 17/93 (18%) HIV acquisition in male circumcision female partners v 8/70 (11%) in control female partners. The difference might have occurred by chance (hazard ratio 1.58, 95% CI: 0.68–3.66, p=0.287), but the point estimate is almost exactly the same size harmful effect as the beneficial effect in men. Unfortunately the trial was stopped early for futility because the conditional power to detect 60% efficacy, was only 4.9%.

The trial authors have never adequately explained why stopping for futility was appropriate, given that the evidence in men was regarded as sufficient to encourage male circumcision.

Can I suggest that until there is a separate Cochrane review for the effect on women, that the outcome "heterosexual acquisition of HIV in female partners" be included in this review?

Wawer MJ, Makumbi F, Kigozi G, et al. Circumcision in HIV-infected men and its effect on HIV transmission to female partners in Rakai, Uganda: a randomised controlled trial. Lancet 2009;374:229-37.