Association between high aflatoxin B1 levels and high viral load in HIV-positive people

Since both aflatoxin and the human immunodeficiency virus (HIV) cause immune suppression, chronic exposure to aflatoxin in HIV-positive people could lead to higher levels of virus replication. This study was conducted to examine the association between aflatoxin B₁ albumin adduct (AF-ALB) levels and HIV viral load. Antiretroviral naive HIV-positive people (314) with median CD4 count of 574 cells/μl blood (mean ± standard deviation = 630±277) were recruited in Kumasi, Ghana. Sociodemographic and health data, and blood samples were collected from participants. The plasma samples were tested for AF-ALB and HIV viral load. Univariate logistic regression analysis was conducted using viral load (high/low) as the outcome and AF-ALB quartiles as exposure. Multivariable logistic regression analysis was performed between quartile AF-ALB, viral load and CD4 adjusting for sex, age, and year of HIV diagnosis. Both univariate and multivariable logistic regression showed that viral load increased as AF-ALB levels increased. By univariate analysis, high viral load was 2.3 times more likely among persons in the third AF-ALB quartile (95% confidence interval (Cl): 1.13, 4.51), and 2.9 times more likely among persons in the fourth AF-ALB quartile (Cl: 1.41, 5.88), compared to persons in the first quartile. In the multivariable model, persons in the fourth AF-ALB quartile were about 2.6 times more likely to have high viral loads than persons in the first quartile (Cl: 1.19-5.69). When AF-ALB and viral load were log transformed and linear regression analysis conducted, the univariate linear regression analysis showed that for each pg/mg increase in AF-ALB, viral load increased by approximately 1.6 copies/ml (P=0.0006). The association was marginally significant in the adjusted linear regression model (i.e. for each pg/mg increase in AF-ALB, the mean viral load increased by approximately 1.3 copies/ml, P=0.073). These data show strong and consistent increases in HIV viral load with increasing AF-ALB levels. Since the median and mean CD4 were greater than 500 cells for participants in each AF-ALB quartile, the results indicate that the immune modulating and virus transcription effects of aflatoxin may occur quite early in HIV infection, even while the CD4 count is still above 500, resulting in higher viral loads.

Socio-demographic determinants of aflatoxin B1-lysine adduct levels among pregnant women in Kumasi, Ghana

OBJECTIVES

Aflatoxins are fungal metabolites that contaminate staple food crops in many developing countries. Although studies have linked these toxins to adverse birth outcomes and poor infant development, no study has investigated the socio-demographic and economic determinants of aflatoxin levels among pregnant women living in sub-Saharan Africa.

DESIGN

A cross-sectional study was conducted among 785 pregnant women in Kumasi. Aflatoxin B1 lysine adduct levels (AF-ALB) were determined by High Performance Liquid Chromatography. Analysis of variance was used to determine mean log AF-ALB levels and significance of differences in these levels according to socio-demographic variables. Logistic regression was used to identify independent associations of socio-demographics with having AF-ALB levels (≥ 11.34 pg/mg; upper quartile).

RESULTS

AF-ALB levels ranged from 0.44 pg/mg to 268.73 pg/mg albumin with a median level of 5.0 pg/mg. Bivariate analyses indicates that mean ln AF-ALB as well as the percent of women having high AF-ALB levels (≥ 11.34 pg/mg; upper quartile) were inversely associated with indices of higher socioeconomic status: higher education and income, being employed and having a flush toilet. Higher income, being employed, having one child (verses no children) and having a flush toilet (verses no toilet facilities) were each independently associated with a 30-40% reduced odds of high AF-ALB levels.

CONCLUSIONS

Additional research is needed to investigate how socio-demographic and economic factors interact to influence aflatoxin ingestion by individuals in regions with high aflatoxin crop contamination. This knowledge can be used to formulate and implement policies that will reduce exposure of women and their unborn children to these toxins.

NovaSil clay intervention in Ghanaians at high risk for aflatoxicosis. I. Study design and clinical outcomes

A 3-month double-blind and placebo-controlled, phase IIa clinical trial was conducted in Ghana to investigate the safety, tolerance and aflatoxin-sorption efficacy of dietary NovaSil (NS). Volunteers (507 subjects) were clinically screened to evaluate their general health, pregnancy status and blood AFB(1)-albumin adduct levels. Of these subjects, 177 were randomly assigned to three groups: high-dose (HD), low-dose (LD) and placebo-control (PL) groups receiving 3.0, 1.5 and 0 g NS day(-1) in capsules. Trained study-monitors supervised NS capsule administration to participants and recorded side-effects daily. Physical examinations were performed monthly. Blood and urine samples were collected for laboratory analysis. Approximately 92% of the participants (162 of 177) completed the study and compliance rate was over 97%. Overall, 99.5% of person x time reported no side-effects throughout the study. Mild to moderate health events ( approximately 0.5% of person x time) were recorded in some participants. Symptoms included nausea, diarrhea, heartburn and dizziness. These side-effects were statistically similar among all three groups. No significant differences were shown in hematology, liver and kidney function or electrolytes in the three groups. These findings demonstrate that NS clay is apparently safe and practical for the protection of humans against aflatoxins in populations at high risk for aflatoxicosis.

Effects of some groundnut packaging methods and protection with Ocimum and syzygium powders on kernel infection by fungi

Powders from the leaves of Ocimum gratissimum and cloves of Syzygium aromaticum were used as protectants at 3% (w/w) in combination with various packaging methods to store 3.5 kg groundnut kernel samples (9.3% moisture) artificially inoculated with Aspergillus parasiticus. Phostoxin-protected and unprotected samples were the controls. Packaging was accomplished with (i) Jute bags; JB (ii) Interlaced polypropylene bags; IPPB (iii) Polyethylene bags; PB (iv) PB inserted into IPPB and (v) PB inserted into JB. Selected treatments were repeated concurrently with naturally infected kernels (6.6% moisture). With 9.3% moisture kernels, there was a highly significant protectant, packaging method, and protectant X packaging method effect on protection of kernels from fungal infection at 2, 4, and 6 months. Packaging with JB and IPPB with or without plant powders gave 100% protection against fungi but insect infestation was prevented only when the Syzygium powder was used. When PB was used either singly or in combination with JB and IPPB, 100% protection from fungi was achieved up to 2 months with the Ocimum and up to 4 months with the Syzygium powder. The phostoxin treatment also gave 100% protection with JB and IPPB packaging but was ineffective with PB packaging. Kernels packaged with PB without the powders were extensively mouldy. Kernels with natural mycoflora (6.6% moisture) were free from fungi at 6 months regardless of the protectant and packaging used. In further tests, the Syzygium powder, at 3% and in combination with JB-packaging, effectively suppressed cross infection of healthy kernels (12% moisture) by fungi from diseased kernels when both kernel types occurred in the same lot. At 18.5% kernel moisture and with identical packaging, the Syzygium powder at 3%, was not as effective.

Growth of and aflatoxin production by Aspergillus flavus in peanuts stored under modified atmosphere packaging (MAP) conditions

The combined effects of water activity (aw), storage temperature, headspace oxygen and carbon dioxide concentrations on the growth of, and aflatoxin production by Aspergillus flavus on sterile peanuts were examined using a process optimization technique termed response surface methodology (RSM). Regression analysis of the data indicated that aw, storage temperature and initial headspace oxygen concentration were all significant factors (P < 0.001) affecting the growth of, and aflatoxin production by A. flavus. Extensive growth and aflatoxin production occurred during the first week of storage in most treatment combinations. Maximum growth occurred in peanuts with an aw of 0.97, a storage temperature of 25 degrees C and headspace oxygen of 10% (balance 60:40 carbon dioxide:nitrogen), after 21 days of storage while maximum aflatoxin production occurred at a lower aw of 0.94, after 21 days under similar storage/gaseous conditions. In several treatment combinations, where high levels of aflatoxin (> 20 ng/g) were initially detected, aflatoxin concentration decreased during storage to levels less than the current regulatory limit of 20 ng/g. This study has shown that A. flavus can grow and produce aflatoxin in carbon dioxide enriched atmospheres in the presence of oxygen. It also emphasizes the combined effect of several 'barriers' to inhibit and reduce aflatoxin in MAP products containing various levels of residual oxygen.

Aflatoxins in food: occurrence, biosynthesis, effects on organisms, detection, and methods of control

Aflatoxins are secondary metabolites produced by species of Aspergilli, specifically Aspergillus flavus and Aspergillus parasiticus. These molds are ubiquitous in nature and grow on a variety of substrates, thereby producing aflatoxins. Aflatoxins are of great concern due to their biochemical and biological effects on living organisms. In this article, the occurrence of aflatoxins, their biosynthesis, factors influencing their production, their effects on living organisms, and methods of detection and control in food are reviewed. Future areas of research involving mathematical modeling of factors influencing aflatoxin production and alternative methods of control, such as modified atmosphere packaging, are also discussed.