[pronut-hiv] African Siderosis

["George M. Carter" <fiar@verizon.net>]

http://www.irondisorders.org/Disorders/Siderosis.asp
  African Siderosis

    African iron overload (AIO) (previously known as African siderosis) is 
a condition observed in sub-Saharan Africans. It is characterized by the 
accumulation of large amounts of iron in the reticuloendothelial cells of 
the liver, spleen and bone marrow as well as in hepatocytes. While the 
distribution of iron differs from that seen in classical type 1 
haemochromatosisas, organ dysfunction and high levels of body iron of 
similar magnitude may be found in AIO. AIO was thought to be solely due to 
the consumption of a traditional beer contaminated with iron. The beer has 
a high lactic acid content which is thought to be the reason why iron is 
leached out of the iron containers in which it is brewed. The iron 
concentrations can be as high as 80 to 100 mg per litre and, as the alcohol 
content is low (1 to 3%), consumption of several litres per day is 
possible. Recent work has suggested that a genetic defect in iron 
regulation, together with high dietary iron consumption may be responsible 
for AIO. A defect in the iron transporter ferroportin, responsible for iron 
release from the gut and reticuloendothelial cells, is thought to be a 
possible cause. A mutation in the ferroportin 1 gene has been found to be 
common in populations of West and Southern African origin and is associated 
with a tendency to higher serum ferritin levels. Other mutations of this 
gene are associated with iron overload with a similar tissue distribution 
to that seen in AIO.

Risk Groups: Anyone of African descent. Iron overload is a common condition in Africa where the prevalence of excessive body iron sufficient to cause liver damage affects as many as 10% of the population in some areas.

Spectrum of disease: Cirrhosis and its complications including 
hepatocellular carcinoma. Osteoporosis secondary to ascorbic acid 
deficiency is common in malnourished individuals. Association with heart 
disease, elevated sugar or diabetes and increased pigmentation has been 
described.

Detection: An attending physician can measure serum ferritin and fasting 
serum iron and TIBC (total iron binding capacity) to determine the 
transferrin iron saturation percentage (Tsat%). Characteristically, the 
serum ferritin rises before the development a high Tsat% and a serum 
ferritin greater than 300ng/mL in adult males 200ng/mL adult females with 
normal Tsat% (<45%) may indicate AIO. Liver biopsy will show the 
characteristic distribution of iron.

Treatment: Therapeutic phlebotomy