title: Traditional herbal medicine use associated with liver fibrosis in rural Rakai, Uganda.
abstract: BACKGROUND
  Traditional herbal medicines are commonly used in sub-Saharan Africa and some herbs are known to be hepatotoxic. However little is known about the effect of herbal medicines on liver disease in sub-Saharan Africa.
  
  
  METHODS
  500 HIV-infected participants in a rural HIV care program in Rakai, Uganda, were frequency matched to 500 HIV-uninfected participants. Participants were asked about traditional herbal medicine use and assessed for other potential risk factors for liver disease. All participants underwent transient elastography (FibroScan®) to quantify liver fibrosis. The association between herb use and significant liver fibrosis was measured with adjusted prevalence risk ratios (adjPRR) and 95% confidence intervals (CI) using modified Poisson multivariable logistic regression.
  
  
  RESULTS
  19 unique herbs from 13 plant families were used by 42/1000 of all participants, including 9/500 HIV-infected participants. The three most-used plant families were Asteraceae, Fabaceae, and Lamiaceae. Among all participants, use of any herb (adjPRR = 2.2, 95% CI 1.3-3.5, p = 0.002), herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 2.9-8.7, p<0.001), and herbs from the Lamiaceae family (adjPRR = 3.4, 95% CI 1.2-9.2, p = 0.017) were associated with significant liver fibrosis. Among HIV infected participants, use of any herb (adjPRR = 2.3, 95% CI 1.0-5.0, p = 0.044) and use of herbs from the Asteraceae family (adjPRR = 5.0, 95% CI 1.7-14.7, p = 0.004) were associated with increased liver fibrosis.
  
  
  CONCLUSIONS
  Traditional herbal medicine use was independently associated with a substantial increase in significant liver fibrosis in both HIV-infected and HIV-uninfected study participants. Pharmacokinetic and prospective clinical studies are needed to inform herb safety recommendations in sub-Saharan Africa. Counseling about herb use should be part of routine health counseling and counseling of HIV-infected persons in Uganda.
authors.affiliation: Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda. brandon_auerbach@hms.harvard.edu
authors.forename: Brandon J
authors.initials: BJ
authors.lastname: Auerbach
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Reynolds
authors.forename: Mohammed
authors.initials: M
authors.lastname: Lamorde
authors.forename: Concepta
authors.initials: C
authors.lastname: Merry
authors.forename: Collins
authors.initials: C
authors.lastname: Kukunda-Byobona
authors.forename: Ponsiano
authors.initials: P
authors.lastname: Ocama
authors.forename: Aggrey S
authors.initials: AS
authors.lastname: Semeere
authors.forename: Anthony
authors.initials: A
authors.lastname: Ndyanabo
authors.forename: Iga
authors.initials: I
authors.lastname: Boaz
authors.forename: Valerian
authors.initials: V
authors.lastname: Kiggundu
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Ron H
authors.initials: RH
authors.lastname: Gray
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
authors.forename: David L
authors.initials: DL
authors.lastname: Thomas
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Kirk
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Quinn
authors.forename: Lara
authors.initials: L
authors.lastname: Stabinski
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy; D029001:Herbal Medicine; D006801:Humans; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000453:epidemiology; D008297:Male; D008519:Medicine, Traditional / Q000009:adverse effects*; D010946:Plants, Medicinal / Q000009:adverse effects; D012424:Rural Population; D014454:Uganda / Q000453:epidemiology
chemical_list: D019380:Anti-HIV Agents