title: Aflatoxin exposure and viral hepatitis in the etiology of liver cirrhosis in the Gambia, West Africa.
abstract: BACKGROUND
  Cirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region.
  
  
  OBJECTIVE
  We aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia.
  
  
  METHODS
  Ninety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249(ser) TP53 mutation.
  
  
  RESULTS
  HBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4-14.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0-53.9) and HCV infection (OR = 3.3; 95% CI, 1.2-9.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249(ser) TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1-7.7 and OR = 3.8; 95% CI, 1.5-9.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant.
  
  
  CONCLUSIONS
  Our results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kuniholm
authors.forename: Olufunmilayo A
authors.initials: OA
authors.lastname: Lesi
authors.forename: Maimuna
authors.initials: M
authors.lastname: Mendy
authors.forename: Aliu O
authors.initials: AO
authors.lastname: Akano
authors.forename: Omar
authors.initials: O
authors.lastname: Sam
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Hall
authors.forename: Hilton
authors.initials: H
authors.lastname: Whittle
authors.forename: Ebrima
authors.initials: E
authors.lastname: Bah
authors.forename: James J
authors.initials: JJ
authors.lastname: Goedert
authors.forename: Pierre
authors.initials: P
authors.lastname: Hainaut
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
mesh_terms: D000348:Aflatoxins / Q000633:toxicity*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D005260:Female; D005714:Gambia; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000821:virology*; D008297:Male
chemical_list: D000348:Aflatoxins