CHAPTER ONE

                                                 INTRODUCTION

1.1  Background

The introduction of the Highly Active Antiretroviral Therapy (HAART) has spectacularly changed the prognosis of Human Immunodeficiency Virus (HIV) infection by greatly prolonging the life span of subjects. Unfortunately HAART is associated with increased cardiovascular risks resulting in myocardial infarction occurring in younger age groups (SoRelle , 1998; Sklar and Masur, 2003 ) . Poor lipid profile, impaired glucose tolerance and in a few cases frank diabetes mellitus, redistribution of body fat (lipodystrophy) including abdominal obesity have all been reported (Shaw et al, 1998; Green, 2002; Riddler et al, 2003; Domingo et al, 2008 ). Other studies showed similar metabolic changes, although to a lower extent in HIV positive subjects not on any antiretroviral medication and concluded that HIV infection itself was in part responsible for the increased cardiovascular events

(Carl and Tien, 2004; Caarr and Ory, 2006; Gross, 2006; Mujawar et al, 2006;

Rasheed et al, 2008.). Initially it was thought that the protease inhibitors (PI’s) were responsible for these changes. It is now known that non PI-based HAART also has the same metabolic effect, although the PI’s are worst, with ritonavir at the lead (Papdopoloulos et al, 1998; Levy et al, 2000; Shahmahesh et al, 2001; Fontas et al, 2004.). A study showed a clear evidence that HIV-1 protein and antiretroviral drugs cause endothelial dysfunction, a key step in cardiovascular disease , although the extent of contribution of each is unclear (Kline and Sutliff, 2008) . Most of these studies were done in advanced countries; a record was found of a study done in Africa, still this was a case report of HAART - induced diabetes mellitus (Bakari et al, 2007). The well documented racial \ ethnic and social variation in cardiovascular risk makes it important to evaluate the changes in cardiovascular risk factors in HIV positive black subjects on HAART in a developing country with racial and social environment widely apart from those of advanced countries. A study had found a strong race / ethnic difference in plasma lipids in HIV-1infected individuals on antiretroviral therapy (Foulkes et al, 2006). 

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