Dear Editor

Soilleux & Coleman report a study related to human immunodeficiency virus (HIV) infection through the human foreskin [1] They do not state whether the foreskin tissue was harvested from immature infants or from sexually mature adult males. Immature tissue may behave differently from mature tissue.

Caution must be observed when assuming in vitro viral behaviour is equivalent in vivo.[2] The inner foreskin is bathed in sub-preputial moisture, which has been shown to contain lysozyme and other pathogen fighting substances.[2,3] Lee-Huang et al. report that lysozyme acts against HIV.[2,4] The authors must show that their findings hold true in vivo.

The recent Cochrane Review reports existing studies from Africa to be so methodologically flawed that insufficient evidence exists to support an intervention by circumcision to prevent female to male HIV infection.[2] Three randomized controlled trials (RCTs) are underway, and the results of those RCTs should be awaited.[2]

Even if the RCTs should show a protective effect by circumcision, recently published letters cite other adverse factors that must be considered along with that evidence.[5,6]

George Hill
Executive Secretary
Doctors Opposing Circumcision
Suite 42
2442 NW Market Street
Seattle, Washington 98107
USA
Web: http://www.doctorsopposingcircumcision.org/

References

(1) Soilleux EJ, Coleman N. Expression of DC-SIGN in human foreskin may facilitate sexual transmission of HIV. J Clin Pathol 2004;57:77-8. [Abstract]

(2)Siegfried N, Muller M, Volmink J, Deeks J, Egger M, Low N, Weiss H, Walker S, Williamson P. Male circumcision for prevention of heterosexual acquisition of HIV in men (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software. [Abstract]

(3) Fleiss PM, Hodges FM, Van Howe RS. Immunological function of the human prepuce. Sex Trans Inf 1998;74:364-7.

(4) Lee-Huang S, Huang PL, Sun Y, et al. Lysozyme and RNases as anti-HIV components in beta-core preparations of human chorionic gonadotropin. Proc Natl Acad Sci U S A 1999;96(6):2678-81. [Full Text]

(5) Boyle GJ. Issues associated with the introduction of circumcision into a non-circumcising society. Sex Trans Inf 2003;79:427-8.

(6) Hill G, Denniston GC. HIV and circumcision: new factors to consider. Sex Trans Inf 2003; 79:495-6.