Aflatoxin exposure and viral hepatitis in the etiology of liver cirrhosis in the Gambia, West Africa

Environ Health Perspect. 2008 Nov;116(11):1553-7. doi: 10.1289/ehp.11661. Epub 2008 Jul 10.


Background: Cirrhosis of the liver is thought to be a major cause of morbidity and mortality in sub-Saharan Africa, but few controlled studies on the etiology of cirrhosis have been conducted in this region.

Objectives: We aimed to elucidate the association between environmental and infectious exposures and cirrhosis in The Gambia.

Methods: Ninety-seven individuals were diagnosed with cirrhosis using a validated ultrasound scoring system and were compared with 397 controls. Participants reported demographic and food frequency information. Blood samples were tested for hepatitis B surface antigen (HBsAg), hepatitis B e antigen (HBeAg), hepatitis C virus (HCV) antibody, HCV RNA, and the aflatoxin-associated 249(ser) TP53 mutation.

Results: HBsAg seropositivity was associated with a significant increase in risk of cirrhosis [odds ratio (OR) = 8.0; 95% confidence interval (CI), 4.4-14.7] as was the presence of HBeAg (OR = 10.3; 95% CI, 2.0-53.9) and HCV infection (OR = 3.3; 95% CI, 1.2-9.5). We present novel data that exposure to aflatoxin, as assessed both by high lifetime groundnut (peanut) intake and by the presence of the 249(ser) TP53 mutation in plasma, is associated with a significant increase in the risk for cirrhosis (OR = 2.8; 95% CI, 1.1-7.7 and OR = 3.8; 95% CI, 1.5-9.6, respectively). Additionally, aflatoxin and hepatitis B virus exposure appeared to interact synergistically to substantially increase the risk of cirrhosis, although this was not statistically significant.

Conclusions: Our results suggest that the spectrum of morbidity associated with aflatoxin exposure could include cirrhosis.

Keywords: Africa; The Gambia; aflatoxin; hepatitis B virus; liver cirrhosis; p53; ultrasound.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Aflatoxins / toxicity*
  • Chemical and Drug Induced Liver Injury / etiology*
  • Female
  • Gambia
  • Humans
  • Liver Cirrhosis / chemically induced*
  • Liver Cirrhosis / virology*
  • Male


  • Aflatoxins