title: HIV and hepatocellular and esophageal carcinomas related to consumption of mycotoxin-prone foods in sub-Saharan Africa.
abstract: BACKGROUND
  Promotion of the HIV epidemic by aflatoxin is postulated but not yet established. Sub-Saharan populations commonly consume food contaminated by mycotoxins, particularly aflatoxins (predominantly found in peanut, maize, rice, and cassava) and fumonisins, which occur primarily in maize. Aflatoxin promotes hepatocellular cancer, and fumonisin may promote esophageal cancer.
  
  
  OBJECTIVE
  This analysis was undertaken to test the hypotheses that consumption of mycotoxin-prone staple foods is 1) related to the incidence of HIV infection in Africa and 2) related to "signature" cancer rates confirming exposure to aflatoxins and fumonisins.
  
  
  METHODS
  World Health Organization data for causes of death and the Food and Agriculture Organization per capita consumption data for commodities in sub-Saharan Africa were used. Per capita Gross Domestic Product and the percentage of Muslims (%Muslim) were the socioeconomic data sets exploited. Relations between causes of mortality, consumption of mycotoxin-prone foods, and socioeconomic variables were evaluated. Models for HIV transmission as a function of maize consumption and %Muslim were estimated.
  
  
  RESULTS
  HIV and esophageal cancer deaths were significantly related to maize but were inversely related to %Muslim and rice consumption. HIV infections were minimized (74 compared with 435/100,000 people; odds ratio: 2.41; 95% CI: 1.73, 3.24; P < or = 0.0001) by the combination of low maize consumption and above-median % Muslim. Hepatocellular cancer deaths were positively related to rice but negatively related to maize consumption.
  
  
  CONCLUSIONS
  HIV transmission frequency is positively associated with maize consumption in Africa. The relation between cancer and food suggests that fumonisin contamination rather than aflatoxin is the most likely factor in maize promoting HIV. Changes to the quality of maize may avoid up to 1,000,000 transmissions of HIV annually.
authors.affiliation: College of Agriculture, University of Georgia, Griffin, GA, USA. jhtimwil@uga.edu
authors.forename: Jonathan H
authors.initials: JH
authors.lastname: Williams
authors.forename: Jessica A
authors.initials: JA
authors.lastname: Grubb
authors.forename: Jerry W
authors.initials: JW
authors.lastname: Davis
authors.forename: Jia-Sheng
authors.initials: JS
authors.lastname: Wang
authors.forename: Pauline E
authors.initials: PE
authors.lastname: Jolly
authors.forename: Nii-Ayi
authors.initials: NA
authors.lastname: Ankrah
authors.forename: William O
authors.initials: WO
authors.lastname: Ellis
authors.forename: Evans
authors.initials: E
authors.lastname: Afriyie-Gyawu
authors.forename: Natalie M
authors.initials: NM
authors.lastname: Johnson
authors.forename: Abraham G
authors.initials: AG
authors.lastname: Robinson
authors.forename: Timothy D
authors.initials: TD
authors.lastname: Phillips
mesh_terms: D017954:Africa South of the Sahara / Q000453:epidemiology; D044383:Black People; D006528:Carcinoma, Hepatocellular / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D002423:Cause of Death; D004777:Environment; D004938:Esophageal Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D005247:Feeding Behavior; D005517:Foodborne Diseases / Q000150:complications*; D037341:Fumonisins / Q000633:toxicity; D015658:HIV Infections / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality / Q000635:transmission; D006801:Humans; D008113:Liver Neoplasms / Q000139:chemically induced / Q000453:epidemiology* / Q000401:mortality; D009026:Mortality; D009183:Mycotoxins / Q000633:toxicity*; D012275:Oryza / Q000633:toxicity; D012044:Regression Analysis; D003313:Zea mays / Q000633:toxicity
chemical_list: D037341:Fumonisins; D009183:Mycotoxins