The high prevalence of human immunodeficiency virus infection and the emergence of HIV-related metabolic syndrome from its successful treatment in African countries are discussed. The classical factors fuelling metabolic syndrome as well as the role of urbanization are considered in this review. The future impact of ongoing conflicts and famine in large parts of Africa on the burden of metabolic syndrome in this region is given some attention. The current pattern of metabolic syndrome in Africa may be modified to an even more distinct form, far from that seen elsewhere.