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

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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.

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Most cited references 37

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Traditional herbal drugs of Bulamogi, Uganda: plants, use and administration

J.R.S. Tabuti, K.A. Lye, S.S Dhillion (2003)

We present here an inventory of the medicinal plants of Bulamogi county in Uganda, including their medicinal use, preparation and administration modes. Fieldwork for this study was conducted between June 2000 and June 2001 using semi-structured interviews, questionnaires, and participant observation as well as transect walks in wild herbal plant collection areas. We recorded 229 plant species belonging to 168 genera in 68 families with medicinal properties. A large proportion of these plants are herbaceous. The medicinal plants are mainly collected from the wild. Some species, such as Sarcocephalus latifolius (Smith) Bruce, are believed by the community to be threatened by unsustainable intensities of use and patterns of harvesting. Particularly vulnerable are said to be the woody or the slow growing species. Herbal medicines are prepared as decoctions, infusions, powders, or as ash, and are administered in a variety of ways. Other concoctions consist of juices and saps. The purported therapeutic claims await validation. Validation in our opinion can help to promote confidence among users of traditional medicine, and also to create opportunities for the marketing of herbal medicines and generate incomes for the community. The processing, packaging and storage of herbal medicines is substandard and require improvement.

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A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

R. Gray, Changgong Li, D Serwadda … (1998)

To describe the design and first-round survey results of a trial of intensive sexually transmitted disease (STD) control to reduce HIV-1 incidence. Randomized, controlled, community-based trial in Rakai District, Uganda. In this ongoing study, 56 communities were grouped into 10 clusters designed to encompass social/sexual networks; clusters within blocks were randomly assigned to the intervention or control arm. Every 10 months, all consenting resident adults aged 15-59 years are visited in the home for interview and sample collection (serological sample, urine, and, in the case of women, self-administered vaginal swabs). Sera are tested for HIV-1, syphilis, gonorrhea, chlamydia, trichomonas and bacterial vaginosis. Following interview, all consenting adults are offered directly observed, single oral dose treatment (STD treatment in the intervention arm, anthelminthic and iron-folate in the control arm). Treatment is administered irrespective of symptoms or laboratory testing (mass treatment strategy). Both arms receive identical health education, condom and serological counseling services. In the first home visit round, the study enrolled 5834 intervention and 5784 control arm subjects. Compliance with interview, sample collection and treatment was high in both arms (over 90%). Study arm populations were comparable with respect to sociodemographic and behavioral characteristics, and baseline HIV and STD rates. The latter were high: 16.9% of all subjects were HIV-positive, 10.0% had syphilis, and 23.8% of women had trichomonas and 50.9% had bacterial vaginosis. Testing the effects of STD control on AIDS prevention is feasible in this Ugandan setting.

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Upper limits of normal for alanine aminotransferase activity in the United States population.

E. Rühl, James E Everhart (2012)

Alanine aminotransferase (ALT) is an important test for liver disease, yet there is no generally accepted upper limit of normal (ULN) in the United States. Furthermore, the ability of ALT to differentiate persons with and without liver disease is uncertain. We examined cut-offs for ALT for their ability to discriminate between persons with positive hepatitis C virus (HCV) RNA and those at low risk for liver injury in the U.S. population. Among adult participants in the 1999-2008 U.S. National Health and Nutrition Examination Survey, 259 were positive for serum HCV RNA and 3,747 were at low risk for liver injury (i.e., negative HCV RNA and hepatitis B surface antigen, low alcohol consumption, no evidence of diabetes, and normal body mass index and waist circumference). Serum ALT activity was measured centrally. Maximum correct classification was achieved at ALT = 29 IU/L for men (88% sensitivity, 83% specificity) and 22 IU/L (89% sensitivity, 82% specificity) for women. The cut-off for 95% sensitivity was an ALT = 24 IU/L (70% specificity) for men and 18 IU/L (63% specificity) for women. The cut-off for 95% specificity was ALT = 44 IU/L (64% sensitivity) for men and 32 IU/L (59% sensitivity) for women. The area under the curve was 0.929 for men and 0.915 for women. If the cut-offs with the best correct classification were applied to the entire population, 36.4% of men and 28.3% of women would have had abnormal ALT. ALT discriminates persons infected with HCV from those at low risk of liver disease, but would be considered elevated in a large proportion of the U.S. population. Copyright © 2011 American Association for the Study of Liver Diseases.

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Author and article information

Contributors

Lara Stabinski: On behalf of : on behalf of the Rakai Health Sciences Program

John E. Tavis: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, USA )

ISSN (Electronic): 1932-6203

Publication date Collection: 2012

Publication date (Electronic): 27 November 2012

Volume: 7

Issue: 11

Electronic Location Identifier: e41737

Affiliations

[1 ]Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda

[2 ]Harvard Medical School, Boston, Massachusetts, United States of America

[3 ]Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America

[4 ]Division of Infectious Diseases, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America

[5 ]Department of Pharmacology and Therapeutics, School of Medicine, University of Dublin, Trinity College, Dublin, Ireland

[6 ]St James's Hospital, Dublin, Ireland

[7 ]Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda

[8 ]Department of Botany, Makerere University, Kampala, Uganda

[9 ]Rakai Health Sciences Program, Entebbe, Uganda

[10 ]Department of Population, Family, and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

[11 ]Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America

Saint Louis University, United States of America

Author notes

* E-mail: brandon_auerbach@ 123456hms.harvard.edu

Competing Interests: The authors have declared that no competing interests exist.

Conceived and designed the experiments: LS SJR TCQ PO GDK. Performed the experiments: LS SJR IB PO. Analyzed the data: BJA LS GDK AN. Contributed reagents/materials/analysis tools: CKB. Wrote the paper: BJA LS. Provided additional technical assistance and contributed to interpretation of the data: BJA CKB ML CM AS PO VK IB FN AN MJW RHG DLT.

Article

Publisher ID: PONE-D-11-10621

DOI: 10.1371/journal.pone.0041737

PMC ID: 3507824

PubMed ID: 23209545

SO-VID: 68f5c87d-cf57-4513-bfa2-a7f7d7d3b559

License:

This is an open-access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

History

Date received : 6 June 2011

Date accepted : 28 June 2012

Page count

Pages: 8

Funding

The study was primarily funded by the United States National Institutes of Health (NIH) Bench to Bedside Program. Additional support was provided by the Division of Intramural Research, National Institutes of Allergy and Infectious Diseases, National Institutes of Health. Support was also provided by the National Institute on Drug Abuse (PI: DLT, R01-AI-16078) and the American Cancer Society (PI: GDK, MRSG-07-284-01-CCE). The study was jointly conducted and benefited from close collaboration of researchers from the intramural NIH Laboratory of Immunoregulation, Johns Hopkins University, the Infectious Diseases Institute of Makerere University, and the Rakai Health Sciences Program. Support for the RHSP HIV Care Program was provided by the President's Emergency Fund for AIDS Relief (PEPFAR) and support for the Rakai Community Cohort Study was provided by the Department of the Army, United States Army Medical Research and Material Command Cooperative Agreement DAMD17-98-2-8007; grants R01 A134826 and R01 A134265 from the National Institute of Allergy and Infectious Diseases; grant R01 016078 (DLT) from the National Institute on Drug Abuse; and grant 5P30HD06826 from the National Institute of Child and Health Development. BJA and ASS were funded by the Fogarty International Clinical Research Scholars (FICRS) program of the NIH, administered by the Vanderbilt University Institute for Global Health (R24 TW007988). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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

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Abstract

Background

Methods

Results

Conclusions

Related collections

PLOS Climate

Most cited references 37

Traditional herbal drugs of Bulamogi, Uganda: plants, use and administration

A randomized, community trial of intensive sexually transmitted disease control for AIDS prevention, Rakai, Uganda.

Upper limits of normal for alanine aminotransferase activity in the United States population.

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