The prevention and treatment of hypertension is marginalized in South Africa by the overwhelming prevalence of HIV. HIV-1 infection and the treatment thereof paradoxically affect cardiovascular risk factors and may add to the cardiovascular risk of these individuals.

We aimed to compare the 5 year cardiovascular changes of black South Africans who were (a) HIV-1 infected without treatment, (b) HIV-1 infected with antiretroviral therapy and (c), uninfected. In this study 164 uninfected and 145 HIV-1 infected (77 never-treated and 68 treated) participants were followed-up after a 5 year period. Two hundred and ninety one participants were lost to follow-up, 11 were newly HIV infected, 39 died and 241 did not partake. The cardiovascular and anthropometric variables were assessed and the percentage change determined. Follow-up analysis (cross-sectional) showed a lower IMT (p<0.01), central systolic blood pressure (p<0.01) and augmentation index (p=0.03) in the HIV infected compared to the HIV uninfected participants. After 5 years (2005-2010) the treated HIV-1 infected participants showed an increase in pulse pressure (p=0.03) and no change in pulse wave velocity, whilst a decrease (p=0.02) was encountered in the never-treated HIV infected participants. No difference in the % change was seen between the treated and uninfected participants.

In conclusion, the cardiovascular profile of the treated HIV-1 infected Africans show signs of an early development of arterial dysfunction over 5 years which is not seen in the never-treated participants. How the antiretroviral therapy is going to influence the HIV-1 infected South Africans’ long-term risk for cardiovascular disease remains to be seen.