Jolly P E, Inusah S, Lu B, Ellis W O, Nyarko A, Phillips T D, Williams J H
University of Alabama at Birmingham, Department of Epidemiology, School of Public Health, 1665 University Boulevard, RPHB 217, Birmingham, AL 35294-0022, USA.
Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
World Mycotoxin J. 2013;6(3):255-261. doi: 10.3920/WMJ2013.1585. Epub 2013 Jul 22.
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 B 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 (=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, =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.
由于黄曲霉毒素和人类免疫缺陷病毒（HIV）都会导致免疫抑制，HIV阳性人群长期接触黄曲霉毒素可能会导致病毒复制水平升高。本研究旨在探讨黄曲霉毒素B白蛋白加合物（AF-ALB）水平与HIV病毒载量之间的关联。在加纳库马西招募了314名未接受过抗逆转录病毒治疗的HIV阳性人群，他们的CD4细胞计数中位数为574个/μl血液（均值±标准差=630±277）。收集了参与者的社会人口统计学和健康数据以及血样。对血浆样本进行AF-ALB和HIV病毒载量检测。以病毒载量（高/低）为结果、AF-ALB四分位数为暴露因素进行单因素逻辑回归分析。在对性别、年龄和HIV诊断年份进行调整的情况下，对AF-ALB四分位数、病毒载量和CD4进行多因素逻辑回归分析。单因素和多因素逻辑回归均显示，随着AF-ALB水平升高，病毒载量增加。通过单因素分析，与第一四分位数的人群相比，AF-ALB第三四分位数人群的高病毒载量可能性高2.3倍（95%置信区间（Cl）：1.13，4.51），AF-ALB第四四分位数人群的高病毒载量可能性高2.9倍（Cl：1.41，5.88）。在多因素模型中，AF-ALB第四四分位数的人群出现高病毒载量的可能性比第一四分位数的人群高约2.6倍（Cl：1.19 - 5.69）。当对AF-ALB和病毒载量进行对数转换并进行线性回归分析时，单因素线性回归分析显示，AF-ALB每增加1 pg/mg，病毒载量大约增加1.6拷贝/ml（=0.0006）。在调整后的线性回归模型中，该关联具有边缘显著性（即AF-ALB每增加1 pg/mg，平均病毒载量大约增加1.3拷贝/ml，=0.073）。这些数据表明，随着AF-ALB水平升高，HIV病毒载量显著且持续增加。由于每个AF-ALB四分位数的参与者的CD4中位数和均值均大于500个细胞，结果表明，黄曲霉毒素的免疫调节和病毒转录作用可能在HIV感染的早期就会发生，即使CD4细胞计数仍高于500，也会导致更高的病毒载量。
