title: Aflatoxin levels, plasma vitamins A and E concentrations, and their association with HIV and hepatitis B virus infections in Ghanaians: a cross-sectional study.
abstract: BACKGROUND
  Micronutrient deficiencies occur commonly in people infected with the human immunodeficiency virus. Since aflatoxin exposure also results in reduced levels of several micronutrients, HIV and aflatoxin may work synergistically to increase micronutrient deficiencies. However, there has been no report on the association between aflatoxin exposure and micronutrient deficiencies in HIV-infected people. We measured aflatoxin B1 albumin (AF-ALB) adduct levels and vitamins A and E concentrations in the plasma of HIV-positive and HIV-negative Ghanaians and examined the association of vitamins A and E with HIV status, aflatoxin levels and hepatitis B virus (HBV) infection.
  
  
  METHODS
  A cross-sectional study was conducted in which participants completed a demographic survey and gave a 20 mL blood sample for analysis of AF-ALB levels, vitamins A and E concentrations, CD4 counts, HIV viral load and HBV infection.
  
  
  RESULTS
  HIV-infected participants had significantly higher AF-ALB levels (median for HIV-positive and HIV-negative participants was 0.93 and 0.80 pmol/mg albumin, respectively; p <0.01) and significantly lower levels of vitamin A (-16.94 μg/dL; p <0.0001) and vitamin E (-0.22 mg/dL; p <0.001). For the total study group, higher AF-ALB was associated with significantly lower vitamin A (-4.83 μg/dL for every 0.1 pmol/mg increase in AF-ALB). HBV-infected people had significantly lower vitamin A (-5.66 μg/dL; p = 0.01). Vitamins A and E levels were inversely associated with HIV viral load (p = 0.02 for each), and low vitamin E was associated with lower CD4 counts (p = 0.004).
  
  
  CONCLUSIONS
  Our finding of the significant decrease in vitamin A associated with AF-ALB suggests that aflatoxin exposure significantly compromises the micronutrient status of people who are already facing overwhelming health problems, including HIV infection.
authors.affiliation: Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
authors.forename: Francis A
authors.initials: FA
authors.lastname: Obuseh
authors.forename: Pauline E
authors.initials: PE
authors.lastname: Jolly
authors.forename: Andrzej
authors.initials: A
authors.lastname: Kulczycki
authors.forename: John
authors.initials: J
authors.lastname: Ehiri
authors.forename: John
authors.initials: J
authors.lastname: Waterbor
authors.forename: Renee A
authors.initials: RA
authors.lastname: Desmond
authors.forename: Peter O
authors.initials: PO
authors.lastname: Preko
authors.forename: Yi
authors.initials: Y
authors.lastname: Jiang
authors.forename: Chandrika J
authors.initials: CJ
authors.lastname: Piyathilake
mesh_terms: D000328:Adult; D000348:Aflatoxins / Q000097:blood / Q000633:toxicity*; D003430:Cross-Sectional Studies; D005260:Female; D005869:Ghana / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology*; D006509:Hepatitis B / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010949:Plasma / Q000737:chemistry; D014801:Vitamin A / Q000097:blood; D014802:Vitamin A Deficiency / Q000150:complications*; D014810:Vitamin E / Q000097:blood; D014811:Vitamin E Deficiency / Q000150:complications*
chemical_list: D000348:Aflatoxins; D014801:Vitamin A; D014810:Vitamin E
references.citation: Biochem Biophys Res Commun. 1993 May 28;193(1):277-83
references.pmid: 8503918
references.citation: MMWR Recomm Rep. 1992 Dec 18;41(RR-17):1-19
references.pmid: 1361652
references.citation: AIDS. 2002 Sep 27;16(14):1935-44
references.pmid: 12351954
references.citation: Br J Nutr. 2003 Apr;89(4):475-82
references.pmid: 12654165
references.citation: J Nutr. 2007 May;137(5):1338-40
references.pmid: 17449602
references.citation: Ann Trop Paediatr. 1987 Dec;7(4):249-51
references.pmid: 2449847
references.citation: Food Addit Contam Part A Chem Anal Control Expo Risk Assess. 2009 Jan;26(1):108-18
references.pmid: 19680878
references.citation: BMC Infect Dis. 2007 Jun 26;7:63
references.pmid: 17594484
references.citation: JAMA. 2000 Jan 5;283(1):74-80
references.pmid: 10632283
references.citation: AIDS. 1995 Sep;9(9):1051-6
references.pmid: 8527077
references.citation: AIDS. 1997 Apr;11(5):613-20
references.pmid: 9108943
references.citation: Int Immunol. 2005 Jun;17(6):807-14
references.pmid: 15944194
references.citation: Am J Vet Res. 1994 Apr;55(4):572-7
references.pmid: 8017706
references.citation: Ann Trop Paediatr. 1996 Jun;16(2):137-40
references.pmid: 8790677
references.citation: Anat Rec. 2000 Apr 1;258(4):338-48
references.pmid: 10737852
references.citation: Int J Food Microbiol. 2000 Nov 1;61(2-3):147-57
references.pmid: 11078165
references.citation: Anat Rec A Discov Mol Cell Evol Biol. 2005 Oct;286(2):899-907
references.pmid: 16086432
references.citation: Arch Intern Med. 1993 Sep 27;153(18):2149-54
references.pmid: 8379807
references.citation: Science. 1990 Oct 19;250(4979):399-404
references.pmid: 2218545
references.citation: Nutr Res. 2007 Jul;27(7):400-407
references.pmid: 18591985
references.citation: Epidemiology. 1998 Jul;9(4):457-66
references.pmid: 9647913
references.citation: Expert Rev Clin Immunol. 2006 Jul;2(4):561-7
references.pmid: 20477613
references.citation: N Engl J Med. 2004 Jul 1;351(1):23-32
references.pmid: 15229304
references.citation: Am J Epidemiol. 1993 Dec 1;138(11):937-51
references.pmid: 7903021
references.citation: Int J Vitam Nutr Res. 2010 Dec;80(6):355-68
references.pmid: 21792816
references.citation: J Acquir Immune Defic Syndr. 2006 Dec 1;43(4):475-82
references.pmid: 17019373
references.citation: Cancer Epidemiol Biomarkers Prev. 1996 Apr;5(4):253-61
references.pmid: 8722216
references.citation: J Acquir Immune Defic Syndr. 2002 Jan 1;29(1):41-8
references.pmid: 11782588
references.citation: Nutr Rev. 2000 Oct;58(10):291-303
references.pmid: 11127968
references.citation: J Food Prot. 1995 Dec;58(12):1395-1404
references.pmid: 31159052
references.citation: Carcinogenesis. 1997 Jun;18(6):1189-94
references.pmid: 9214602
references.citation: Dig Dis Sci. 2005 Mar;50(3):525-32
references.pmid: 15810636
references.citation: Clin Infect Dis. 2003 Apr 15;36(8):1053-62
references.pmid: 12684919
references.citation: J Virol. 1995 Sep;69(9):5838-42
references.pmid: 7637030
references.citation: Arq Gastroenterol. 2009 Jan-Mar;46(1):62-8
references.pmid: 19466312
references.citation: Clin Infect Dis. 1994 Sep;19(3):489-99
references.pmid: 7811869
references.citation: Arch Tierernahr. 1990 May-Jun;40(5-6):517-37
references.pmid: 2241571
references.citation: Clin Infect Dis. 2003;37 Suppl 2:S112-6
references.pmid: 12942384
references.citation: Clin Infect Dis. 2004 Mar 1;38 Suppl 2:S49-55
references.pmid: 14986275
references.citation: Am J Clin Nutr. 1995 Mar;61(3 Suppl):710S-720S
references.pmid: 7879742
references.citation: Semin Roentgenol. 1994 Jul;29(3):275-87
references.pmid: 7939795
references.citation: Mycopathologia. 1996;134(2):109-14
references.pmid: 8981776
references.citation: Int J Hyg Environ Health. 2006 Jul;209(4):345-58
references.pmid: 16644281
references.citation: Lab Invest. 1985 Feb;52(2):182-94
references.pmid: 2578584
references.citation: J Acquir Immune Defic Syndr. 2004 Dec 15;37(5):1657-63
references.pmid: 15577425
references.citation: J Acquir Immune Defic Syndr Hum Retrovirol. 1995;10 Suppl 2:S51-6
references.pmid: 7552513
references.citation: Int J Food Microbiol. 2005 Oct 15;104(2):215-24
references.pmid: 15979184
references.citation: J Infect Dis. 1995 May;171(5):1196-202
references.pmid: 7751694
references.citation: BMJ. 2002 Jul 6;325(7354):20-1
references.pmid: 12098724