Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda

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Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda

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Title: Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda
Author: Reynolds, Steven J.; Lamorde, Mohammed; Merry, Concepta; Kukunda-Byobona, Collins; Ocama, Ponsiano; Semeere, Aggrey S.; Ndyanabo, Anthony; Boaz, Iga; Kiggundu, Valerian; Nalugoda, Fred; Gray, Ron H.; Wawer, Maria J.; Kirk, Gregory D.; Stabinski, Lara; Auerbach, Brandon Joseph; Thomas, David L.; Quinn, Thomas C.

Note: Order does not necessarily reflect citation order of authors.

Citation: Auerbach, Brandon Joseph, Steven J. Reynolds, Mohammed Lamorde, Concepta Merry, Collins Kukunda-Byobona, Ponsiano Ocama, Aggrey S. Semeere, et al. 2012. Traditional herbal medicine use associated with liver fibrosis in rural Rakai, Uganda. PLoS ONE 7(11): e41737.
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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.
Published Version: doi:10.1371/journal.pone.0041737
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