Association between the exposure to aflatoxin and micronutrient status of HIV infected adults in Ghana

by Obuseh, Francis Ayodele.

Aflatoxins, found naturally in some foods are toxic metabolites of some Aspergillus species.They constitute the most potent hepatocarcinogens known and are also mutagenic and hepatotoxic. The preponderance of evidence indicates that aflatoxin is the major cause of hepatocellular cancer. In studies conducted in Africa, food-borne aflatoxin exposure is common (Oyelami et al. 1996; Egal et al. 2005). There is a critical need for additional information on health outcomes associated with exposure to aflatoxin in humans, especially in developing countries with a higher degree of malnutrition and likelihood of HIV infections. We sought to test the hypothesis that aflatoxin B1 and M1 both predict vitamin A and E status. We conducted a cross-sectional survey to determine the relationship between aflatoxins and vitamin A and E levels in participants from a major peanut and maize growing and consumption region in southern Ghana. We found a negative relationship between plasma AFB1 albumin adducts and serum vitamin A and E, and a positive relationship between plasma AFB1 albumin adducts and serum vitamin A and E. We further assessed the risk factors associated with exposure and consumption of aflatoxin and the relationship between the exposure to and consumption of aflatoxins and the micronutrients of HIV patients. Analyses showed that being exposed to aflatoxin and being infected with HIV both decreased plasma vitamin A in great proportion. However, there was no interaction effect between aflatoxin and HIV infection. Being infected with HIV also decreased plasma vitamin E, but there was no association between aflatoxin and plasma vitamin E in HIV-infected adults. We found a strong relationship between vitamins A and E and viral load, also vitamin E was associated with HIV disease progression. Other predictors of vitamin A status were sex and hepatitis B infection. We conducted a cross-sectional survey to determine if sex was associated with disease severity among HIV-infected adults. We found few socio-demographic parameters to be predictive of infections in the study sample. There were no sex differences in disease severity and women were more likely to have lower viral load. Women with the advanced stage of the disease were also more likely to be deficient in vitamin A compared to their male counterparts. iii