Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda

Background: Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic. However little is known about the effect of herbal medicines on liver disease in sub-Saharan Africa. Methods: 500 HIV-infected participants in a rural HIV care program in Rakai, Uganda, were frequency matched to 500 HIV-uninfected participants. Participants were asked about traditional herbal medicine use and assessed for other potential risk factors for liver disease. All participants underwent transient elastography (FibroScan®) to quantify liver fibrosis. The association between herb use and significant liver fibrosis was measured with adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CI) using modified Poisson multivariable logistic regression. Results: 19 unique herbs from 13 plant families were used by 42/1000 of all participants, including 9/500 HIV-infected participants. The three most-used plant families were Asteraceae, Fabaceae, and Lamiaceae. Among all participants, use of any herb (adjPRR = 2.2, 95% CI 1.3–3.5, p = 0.002), herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 2.9–8.7, p<0.001), and herbs from the Lamiaceae family (adjPRR = 3.4, 95% CI 1.2–9.2, p = 0.017) were associated with significant liver fibrosis. Among HIV infected participants, use of any herb (adjPRR = 2.3, 95% CI 1.0–5.0, p = 0.044) and use of herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 1.7–14.7, p = 0.004) were associated with increased liver fibrosis. Conclusions: Traditional herbal medicine use was independently associated with a substantial increase in significant liver fibrosis in both HIV-infected and HIV-uninfected study participants. Pharmacokinetic and prospective clinical studies are needed to inform herb safety recommendations in sub-Saharan Africa. Counseling about herb use should be part of routine health counseling and counseling of HIV-infected persons in Uganda

Sub-Optimal Vitamin B-12 Levels among ART-Naïve HIV-Positive Individuals in an Urban Cohort in Uganda

Malnutrition is common among HIV-infected individuals and is often accompanied by low serum levels of micronutrients. Vitamin B-12 deficiency has been associated with various factors including faster HIV disease progression and CD4 depletion in resource-rich settings. To describe prevalence and factors associated with sub-optimal vitamin B-12 levels among HIV-infected antiretroviral therapy (ART) naïve adults in a resource-poor setting, we performed a cross-sectional study with a retrospective chart review among individuals attending either the Mulago-Mbarara teaching hospitals’ Joint AIDS Program (MJAP) or the Infectious Diseases Institute (IDI) clinics, in Kampala, Uganda. Logistic regression was used to determine factors associated with sub-optimal vitamin B-12. The mean vitamin B-12 level was 384 pg/ml, normal range (200–900). Sub-optimal vitamin B-12 levels (<300 pg/ml) were found in 75/204 (36.8%). Twenty-one of 204 (10.3%) had vitamin B-12 deficiency (<200 pg/ml) while 54/204 (26.5%) had marginal depletion (200–300 pg/ml). Irritable mood was observed more among individuals with sub-optimal vitamin B-12 levels (OR 2.5, 95% CI; 1.1–5.6, P = 0.03). Increasing MCV was associated with decreasing serum B-12 category; 86.9 fl (±5.1) vs. 83 fl (±8.4) vs. 82 fl (±8.4) for B-12 deficiency, marginal and normal B-12 categories respectively (test for trend, P = 0.017). Compared to normal B-12, individuals with vitamin B-12 deficiency had a longer known duration of HIV infection: 42.2 months (±27.1) vs. 29.4 months (±23.8; P = 0.02). Participants eligible for ART (CD4<350 cells/µl) with sub-optimal B-12 had a higher mean rate of CD4 decline compared to counterparts with normal B-12; 118 (±145) vs. 22 (±115) cells/µl/year, P = 0.01 respectively. The prevalence of a sub-optimal vitamin B-12 was high in this HIV-infected, ART-naïve adult clinic population in urban Uganda. We recommend prospective studies to further clarify the causal relationships of sub-optimal vitamin B-12, and explore the role of vitamin B-12 supplementation in immune recovery

Clinical differences between younger and older adults with HIV/AIDS starting antiretroviral therapy in Uganda and Zimbabwe: a secondary analysis of the DART trial

Clinical and immunological data about HIV in older adults from low and middle income countries is scarce. We aimed to describe differences between younger and older adults with HIV starting antiretroviral therapy in two low-income African countries

Risk factors for sub-optimal serum vitamin B-12 among adult HIV-infected ART naïve participants who did not report using vitamin B-12 containing supplements at two urban HIV clinics in Uganda, in April 2010.

a<p>Adjusted for age, sex, BMI, supplement use, MCV, occupation, irritable mood, known duration with HIV, WHO disease stage and current CD4.</p>b<p>Adjusted for,age, sex, BMI, WHO stage, supplement use.</p><p><b>BMI</b>- Body Mass Index, <b>MCV</b>-Mean Corpuscular Volume, <b>OR</b> Odds Ratio, <b>WHO</b>-World health Organization.</p

A comparison of characteristics by serum vitamin B-12 group among adult HIV-infected ART naïve participants at two urban HIV clinics in Uganda, in April 2010.

<p><b>IQR-</b> Inter Quartile Range, <b>BMI</b>- Body Mass Index, <b>WHO</b>-World health Organization, <b>MCV</b>-Mean Corpuscular Volume, <b>Hb</b>- Hemoglobin. <b>IDI</b>- Infectious Disease Institute, <b>MJAP</b>- Mulago-Mbarara Teaching Hospitals’ Joint AIDS Program T-tests were used to compare means and the chi-square for proportions, except where mentioned.</p>a<p>Some missing data. N = 113 for Normal B-12 & 70 for Sub-Optimal B-12.</p

Logistic regression model for characteristics at ART initiation for adults who were older (≥ 50 years) compared to younger ones (18-50 years) (N=3316).

<p>Abbreviations: ALT – Alanine transaminase; AST – Aspartate transaminase; BMI – Body Mass Index; clear. – clearance; CD4+ – Cluster of Differentiation; CI – Confidence Interval; cp – copies; Cr. – Creatinine; IQR – Inter Quartile Range; Kg – Kilogramme; M² – Meter; SD – Standard Deviation; WHO – World Health Organization; <i>d</i>L – deciliter; g – grams; Hg – mercury; mmol – millimols; mL − milliliter; mm – millimeters; µL – microliter</p><p>* n=968 (</p><p>< 50 years n = 912; > 50 years n = 56) in log 10 copies per milliliter.</p><p>§ <i>Baseline adjusted model;</i> Ω <i>- model with viral load, interaction between gender and hemoglobin; and creatinine clearance (BMI excluded</i>)</p><p>α − WHO stages 2, 3 & 4 included as a linear trend</p