Traditional Herbal Medicine Use Associated with Liver Fibrosis in Rural Rakai, Uganda
HARVARD MEDICAL SCHOOL BOSTON MA
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Traditional herbal medicines are commonly used for HIV AIDS and other health conditions in Uganda and sub-Saharan Africa, often in parallel with programs that provide antiretroviral therapy ART. In the 1990s an estimated 80 of Ugandans living in rural villages used traditional healers for primary health care 1. A study of 137 HIV-infected Ugandans receiving ART found that 60 used herbs concurrently with ART 2. In Uganda traditional herbal medicines are usually boiled extracts of herbs taken orally 3. Some potentially hepatotoxic traditional herbal medicines used in Uganda and sub-Saharan Africa include Hoodia gordoni 4, kava 5, Phytolacca dioica 6, and herbs from the Asteraceae family 7. Little is known about the hepatotoxicity of other commonly used herbs or the contribution of herbs to the burden of liver fibrosis and hepatocellular carcinoma in sub- Saharan Africa, including when used concomitantly with ART. Data on the specific types of herbs taken by HIV-infected persons in Uganda is limited, as is information about their components, side effects, toxicities, and ART interactions 8. In Rakai, Uganda, liver toxicity associated with herbal medicine may be of particular concern given the high prevalence of significant liver disease 17 among HIV-infected persons in Rakai recently identified by transient elastography FibroScanH Echosense, Paris, France 9. In the aforementioned study reported herbal medicine use was associated with a two-fold increased risk of significant liver disease, defined as a transient elastography score equivalent to METAVIR liver fibrosis stage 2 portal fibrosis with few septa or greater 9. The study presented here follows up on this prior investigation with an in-depth analysis of the herbs used by study participants and their relation to liver fibrosis.
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