HIV and hepatocellular and esophageal carcinomas related to consumption of mycotoxin-prone foods in sub-Saharan Africa

Abstract

Background: Promotion of the HIV epidemic by aflatoxin is postulated but not yet established. Sub-Saharan populations commonly consume food contaminated by mycotoxins; particularly aflatoxins predominantly found in peanut, maize, rice and cassava; and fumonisins which occur primarily in maize. Aflatoxin promotes hepatocellular cancer and fumonisin may promote oesophageal cancer. Objective: This analysis was undertaken to test the hypotheses that consumption of mycotoxin8 prone staple foods is: 1) related to incidence of HIV infection in Africa; and 2) related to ‘signature’ cancer rates confirming exposure to aflatoxins and fumonisins. Data & Analyses: WHO data for causes-of-death and the FAO per capita consumption data for commodities in Sub-Saharan Africa were used. Per capita GDP and percent Muslim were social-economic data sets exploited. Relationships between causes of mortality; consumption of mycotoxin-prone foods; and socio-economic variables were evaluated. Models for HIV transmission rate as a function of maize consumption and Muslim prevalence were estimated. Results: HIV and oesophageal cancer deaths were significantly related to maize; but were inversely related to Muslim%, and rice consumption. HIV infections were minimized (74 v 435 100,000-1 17 people: OR=2.41: 95% CI 1.73, 3.24: P=<0.0001) by the combination of low maize consumption and above-median Muslim prevalence. Hepatocellular cancer deaths were positively related to rice but negatively to maize consumption. Conclusions: HIV transmission frequency increases with maize consumption. Cancer relationships to foods suggest that fumonisin contamination and not aflatoxin is the mostly likely feature in maize promoting HIV. Changing maize quality may avoid up to 1,000,000 transmissions annually.