Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
PLoS ONE
Abstract
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 HIVuninfected
participants. Participants were asked about traditional herbal medicine use and assessed for other potential risk
factors for liver disease. All participants underwent transient elastography (FibroScanH) 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.
Description
Keywords
Traditional Herbal Medicine, Liver Fibrosis, Rural Rakai, Uganda
Citation
Auerbach BJ, Reynolds SJ, Lamorde M, Merry C, Kukunda-Byobona C, et al. (2012) Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda. PLoS ONE 7(11): e41737. doi:10.1371/journal.pone.0041737