184808 Aflatoxin exposure and health characteristics associated with vitamin A and E levels in HIV positive individuals in the Southern Ghana, West Africa

Wednesday, October 29, 2008

Francis A. Obuseh, DrPH, MPH, MS , 436th Aeromedical-Dental Squadron, United States Air Force, Dover, DE
Yi Jiang, MD, MPH , Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL
Peter Preko, MD, MPH , ICAP-Swaziland, Columbia University, Eveni, Swaziland
Andrzej Kulczycki, PhD , Department of Maternal and Child Health, The University of Alabama at Birmingham, Birmingham, AL
John E. Ehiri, PhD; MPH , School of Public Health, University of Alabama at Birmingham, Birmingham, AL
John Waterbor, MD , Department of Epidemiology, School of Public Health, Birmingham, AL
Chandrika Piyathilake, PhD , Nutritional Biochemistry & Genomics, University of Alabama at Birmingham, Birmingham, AL
William Ellis, PhD , Department of Biochemistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
Jia-Sheng Wang, MD, PhD , Department of Environmental Toxicology, Texas Tech University, Lubbock, TX
Jonathan Williams, PhD , College of Agricultural and Environmental Sciences, University of Georgia, Griffin, GA
Pauline Jolly, PhD, MPH , Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL

There is substantial evidence that aflatoxin exposure is common in Africa. This exposures compromises immunity and enhances macro- and micronutrient malnutrition. There is a paucity of data on the impact of aflatoxin exposure in people with a higher degree of malnutrition and the likelihood of HIV infections.


We conducted a cross-sectional survey to investigate health relation of characteristics such as HIV status, acute aflatoxicosis, liver function, hepatitis B and C infection to Vitamin A and Vitamin E plasma concentration.


Median plasma aflatoxin B1 albumin adduct (AF-ALB) level for HIV positive participants was 0.93 pmol/mg albumin, and for HIV negative participants was 0.80 pmol/mg albumin (P<0.01). Analyses showed that: (1) for each 1 pmol/mg albumin increase in plasma aflatoxin, the plasma vitamin A decreased by 4.38 g/dL; (2) infection with HIV decreased plasma vitamin A by 14.70 g/dL and E by 13.70 g/dL (P< 0.0001); and (3) Hepatitis B virus infection decreased plasma vitamin A by 5.66 g/dL (P< 0.0001) compared to those with no infection. We found no significant associations between vitamin A and HIV viral load or between vitamin A and CD4+ T cell counts. However, results showed significant associations between vitamin E and CD4 counts (p = 0.02), and HIV viral load (p = 0.0008).


The decrease in micronutrients associated with aflatoxin exposure may translate into a significantly higher risk of HIV disease progression. This suggests that aflatoxicosis prevention should be a part of routine HIV care in Ghana and other resource poor communities.

Learning Objectives:
Participants will be able to: identify the health characteristics and afloxtoxin levels in relation to vitamin A and vitamin E levels among those living with HIV quantify the risk of micronutrient deficiency associated with exposure to aflatoxin among people living with HIV assess levels of health risk due to exposure to aflatoxin

Keywords: HIV/AIDS, International Public Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Degree Year Department School MS 1992 Human Nutrition University of Ibadan, Nigeria. MPH 2003 Epidemiology University of Alabama, US. DrPH 2007 Public Health University of Alabama, US.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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