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Rheumatic heart disease in Uganda: the association between MHC class II HLA DR alleles and disease: a case control study.
[acute rheumatic fever]
Rheumatic
heart
disease
(
RHD
)
,
the
only
long
term
consequence
of
acute
rheumatic
fever
,
remains
a
leading
cause
of
morbidity
and
mortality
among
young
adults
in
Uganda
.
An
inherited
susceptibility
to
acute
rheumatic
fever
centers
around
the
major
histocompatibility
class
II
human
leucocyte
antigens
.
However
,
there
is
paucity
of
data
from
sub-
Saharan
Africa
.
This
study
compares
the
frequency
of
HLA
class
II
DR
alleles
between
RHD
cases
and
normal
controls
in
Uganda
.
One
hundred
ninety-
nine
participants
including
96
established
RHD
cases
aged
5
-
60
years
and
103
age
and
sex
matched
normal
controls
were
recruited
for
participation
.
DNA
was
manually
extracted
from
buffy
coat
samples
and
HLA
analysis
was
performed
.
HLA-
DR
allelic
frequency
comparison
between
cases
and
controls
were
estimated
using
conditional
logistic
regression
with
95
%
confidence
intervals
.
P
-
values
were
corrected
for
multiple
hypothesis
testing
.
199
participants
(
103
female
,
51
.
8
%
)
completed
the
study
.
The
mean
(
SD
)
age
in
years
for
cases
and
controls
were
29
.
6
(
10
.
2
)
and
29
(
18
)
,
respectively
.
After
conditional
logistic
regression
and
multiple
hypothesis
testing
,
HLA-
DR
1
was
associated
with
a
decreased
risk
of
RHD
(
OR
=
0
.
42
,
CI
0
.
21
-
085
,
P
=
0
.
01
,
Corrected
P
value
(
PC
)
 
=
0
.
09
,
)
while
HLA-
DR
1
1
was
associated
with
increased
risk
of
RHD
(
OR
=
3
.
31
,
CI
1
.
57
-
6
.
97
,
P
=
 
<
0
.
001
,
Pc
<
0
.
001
)
.
No
other
significant
associations
were
found
.
In
this
first
study
of
HLA
genetic
susceptibility
to
RHD
in
Uganda
,
HLA-
DR
1
was
more
common
in
normal
controls
while
HLA-
DR
1
1
was
more
common
among
RHD
cases
suggesting
a
disease
susceptibility
association
.
In
future
studies
,
high
resolution
HLA
analysis
and
genome
wide
studies
should
be
carried
out
to
confirm
this
pattern
.
Diseases
Validation
Diseases presenting
"first study"
symptom
achondroplasia
acute rheumatic fever
alexander disease
aniridia
coats disease
congenital adrenal hyperplasia
cowden syndrome
dystrophic epidermolysis bullosa
erythropoietic protoporphyria
familial hypocalciuric hypercalcemia
familial mediterranean fever
heparin-induced thrombocytopenia
hirschsprung disease
krabbe disease
locked-in syndrome
oculocutaneous albinism
primary effusion lymphoma
waldenström macroglobulinemia
wiskott-aldrich syndrome
zellweger syndrome
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