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

Brandon J. Auerbach, Steven J. Reynolds, Mohammed Lamorde, Concepta Merry, Collins Kukunda-Byobona, Ponsiano Ocama, Aggrey S. Semeere, Anthony Ndyanabo, Iga Boaz, Valerian Kiggundu, Fred Nalugoda, Ron H. Gray, Maria J. Wawer, David L. Thomas, Gregory D. Kirk, Thomas C. Quinn, Lara Stabinski

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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.

Original languageEnglish (US)
Article numbere41737
JournalPloS one
Volume7
Issue number11
DOIs
StatePublished - Nov 27 2012

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ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Auerbach, B. J., Reynolds, S. J., Lamorde, M., Merry, C., Kukunda-Byobona, C., Ocama, P., Semeere, A. S., Ndyanabo, A., Boaz, I., Kiggundu, V., Nalugoda, F., Gray, R. H., Wawer, M. J., Thomas, D. L., Kirk, G. D., Quinn, T. C., & Stabinski, L. (2012). Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda. PloS one, 7(11), [e41737]. https://doi.org/10.1371/journal.pone.0041737