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HLA-B27 and ankylosing spondylitis geographic distribution versus malaria endemic: casual or causal liaison?
  1. A Mathieu1,
  2. A Cauli1,
  3. M T Fiorillo2,
  4. R Sorrentino2
  1. 1
    Rheumatology II, Department of Medical Sciences, University of Cagliari, Cagliari, Italy
  2. 2
    Department of Cell Biology and Development, University of Rome “La Sapienza”, Rome, Italy
  1. Professor Alessandro Mathieu, Chair of Rheumatology II, Department of Medical Sciences, University of Cagliari, SS 554, 09042 Monserrato, Cagliari, Italy; mathieu{at}

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The distinctive feature of the strikingly non-homogeneous geographical distribution of HLA-B271 (fig 1A) is that its frequency is lowest (0%) in the equatorial region and highest (40%) in the arctic and furthest north populations.2 This is compatible with the hypothesis that HLA alleles in general, and –B27 in particular, have been selected by environmental factors.3 Accordingly, it has been shown that HLA-B27 is associated with protection from several viral diseases (AIDS, hepatitis C, and influenza). Although a high frequency of HLA-B27 in some areas may be explained by a founder effect, there are features to suggest that negative selection by …

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  • Competing interests: None declared

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