CARDIOVASCULAR JOURNAL OF AFRICA • Vol 22, No 3, May/June 2011
118
AFRICA
study is published in which we assessed cross-sectionally wheth-
er these newly identified, never-treated, HIV-1-infected Africans
showed signs of inflammatory injury of the endothelium. This
could lead to endothelial dysfunction, accelerated atherosclerosis
and increased coagulation, which could result in thrombosis. Our
findings suggest inflammatory injury of the endothelium, which
was probably worsened by the attenuation of the protective effect
of high-density lipoprotein cholesterol (HDL-C). The high levels
of protective HDL-C in black South Africans is thought to be the
reason for the fairly low prevalence of ischaemic heart disease
in the general population.
22
Although there was no indication
of a prothrombotic state which could result in atherosclerotic
disease, there was an indication of accelerated vascular aging and
probable early atherosclerosis in the older HIV-infected South
Africans. The latter indicates a decrease in vascular function of
the never-treated, HIV-1-infected older population.
23
After being identified as HIV infected, the participants were
referred to their nearest hospital or clinic for follow up on the
diagnosis of HIV infection and commencement of treatment
if needed. Some of the participants were eligible, by CD
4
cell
count, for enrollment in the ART roll-out programme but chose
not to initiate treatment. During the 2008 follow up, our results
showed lower systolic blood pressure and dyslipidaemia in the
never-treated, HIV-1-infected South Africans compared to the
control participants. In the treated HIV-infected participants, we
observed an increase in systolic blood pressure, but no hyperten-
sion, and an improvement in lipid profile.
Although the antiretroviral treatment stabilised the lipid
profile, an increase in lipodystrophy was seen in the treated
group, which may influence the development of future cardio-
vascular disease. Indeed, changes in body composition were one
of the most prominent results of this study. These changes in the
treated group confirm the possible development of lipodystro-
phy, expected after the introduction of antiretroviral treatment.
5,6
Stavudine, the nucleoside reverse transcriptase inhibitor (NRTI)
of the first-line therapy of the roll-out programme is incrimi-
nated in the development of lipodystrophy.
24
New guidelines on
the WHO’s first-line therapy, which came into effect on 1 April
2010 in South Africa, phase out the use of stavudine in favour
of tenofovir.
13
Whether this could have an effect on the develop-
ment of lipodystrophy in the South African population remains
to be seen.
The novel biomarker, soluble urokinase plasminogen activator
receptor (suPAR) is a stable plasma protein
25
and is associated
with inflammation and progression of disease in HIV-1 infec-
tion.
26
It was suggested that suPAR may be a marker linking
inflammatory and metabolic characteristics (lipid and glucose
metabolism, as well as fat redistribution) of HIV-infected
patients on ART.
25
We therefore hypothesised that the HIV-1-
infected black South Africans would have significantly higher
suPAR levels than their uninfected controls. While the latter was
confirmed by our results, the treated HIV-1-infected Africans
unexpectedly showed a significantly greater increase in blood
suPAR levels than never-treated infected or uninfected Africans
after a three-year period. Furthermore, this study indicates an
association of suPAR with the development of lipodystrophy
in HIV-1-infected black South Africans on the WHO’s recom-
mended first-line antiretroviral therapy.
27
In summary, our results clearly indicate a detrimental health
profile in the HIV-infected black population of South Africa
(whether receiving treatment or not). Therefore it remains of the
utmost importance to gain knowledge about the influence of HIV
infection and the treatment thereof on the cardiovascular system
of the South African population.
CMT FOURIE, PhD (Physiology),
JM VAN ROOYEN, DSc
AE SCHUTTE, PhD
Hypertension in Africa Research Team (HART)
North-West University, Potchefstroom, South Africa
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