An Unanswered Question in HIV Care
Millions of people living with HIV now manage the virus successfully thanks to antiretroviral therapy (ART). Even so, treatment does not resolve every underlying problem. Chronic, low-grade inflammation often persists in the body, quietly raising the risk of heart disease and other serious complications over time.
Meanwhile, Ramadan fasting, observed by hundreds of millions of Muslims worldwide, has already shown promise in reducing inflammation among people with diabetes and metabolic syndrome. Until recently, however, nobody had studied whether the same benefit might extend to people living with HIV. A new study from Jakarta finally addresses that gap, and its early findings are worth understanding.
Designing a Careful Comparison
Researchers at Dr. Cipto Mangunkusumo General Hospital, led by Dr. Alvina Widhani, recruited HIV-positive men aged 20 to 40, all stable on first-line ART for at least six months. Crucially, the team split participants into two comparable groups: 29 men who fasted throughout Ramadan and 29 who did not, matched by age, treatment regimen, and treatment duration.
Both groups underwent blood testing before the study began and again after two weeks. Researchers specifically tracked high-sensitivity C-reactive protein, commonly known as hs-CRP, a sensitive marker of inflammation strongly associated with cardiovascular risk. They also measured total antioxidant status, or TAOS, which reflects the body’s overall capacity to neutralize cellular damage.
Beyond blood tests, the team recorded detailed lifestyle data. Diet, physical activity, smoking habits, sleep quality, and even anxiety and depression scores were tracked throughout the two-week period. This thoroughness allowed researchers to rule out several alternative explanations for any changes observed.
Study Groups at a Glance
| Detail | Fasting Group | Non-Fasting Group |
|---|---|---|
| Number of participants | 29 | 29 |
| Median age | 35 years | 35 years |
| Fasting duration tracked | 14 consecutive days | Not applicable |
| Baseline hs-CRP (inflammation marker) | 0.15 mg/L | 0.12 mg/L |
| Baseline body mass index | 21.3 kg/m² | 23.4 kg/m² |
| Cigarettes smoked per day (baseline) | 6 (median) | 1 (median) |
What Happened to Inflammation and Health Markers?
This table shows how the two groups changed after 2 weeks. A “p-value” below 0.05 means the change was real and not just by chance.
| Health Indicator | Fasting Group (29 people) | Non-Fasting Group (29 people) | Was the Difference Real? |
|---|---|---|---|
| Inflammation Level (hs-CRP) | Went DOWN by 0.41 mg/L | Went UP by 0.20 mg/L | ✅ YES (p=0.004) – Fasting clearly helped lower inflammation |
| Antioxidant Level (TAOS) | Went up slightly by 0.05 mmol/L | Went up slightly by 0.04 mmol/L | ❌ NO (p=0.405) – Both groups saw similar small changes |
| Body Weight | Dropped by about 2 kg | Stayed about the same | ✅ YES (p<0.001) – Fasters lost weight |
| Cigarettes Smoked Per Day | Dropped from 6 to 3 cigarettes | Stayed about the same | ✅ YES (p<0.001) – Fasters smoked much less |
| Sleep Hours Per Day | Dropped from 7 to 5 hours | Stayed about the same | ✅ YES (p<0.001) – Fasters slep |
What Happened to Inflammation Levels
After two weeks, the results stood out clearly. hs-CRP fell by a median of 0.41 mg/L in the fasting group. In contrast, hs-CRP actually rose by a median of 0.20 mg/L among participants who did not fast. This difference reached statistical significance, meaning it was unlikely to result from chance alone.
Digging deeper, researchers ran a regression analysis to quantify fasting’s specific contribution. The results showed that Ramadan fasting explained about 10% of the variation in hs-CRP change, an effect described mathematically as a decrease of roughly 0.317 points attributable to fasting itself. For context, hs-CRP is measured in fractions of a single milligram per liter, so even modest shifts can carry clinical meaning over time, particularly for a population already facing elevated cardiovascular risk.
However, not every measured outcome moved in fasting’s favor. Total antioxidant status increased slightly in both groups, and the fasting group’s improvement was not significantly greater than the control group’s. Therefore, unlike some previous studies in other populations, this particular study did not find clear evidence that fasting specifically boosted antioxidant defenses within this short timeframe.
Key Outcomes After Two Weeks
| Measurement | Fasting Group Change | Non-Fasting Group Change | Statistically Significant? |
|---|---|---|---|
| hs-CRP (inflammation marker) | −0.41 mg/L | +0.20 mg/L | Yes (p = 0.004) |
| Total antioxidant status | +0.05 mmol/L | +0.04 mmol/L | No (p = 0.405) |
| Body weight | −2 kg | No significant change | Yes (p = 0.001) |
| Cigarettes smoked per day | −1 (median) | No change | Yes (p < 0.001) |
| Total sleep hours per day | −2 hours | No significant change | Yes (p = 0.001) |
Ruling Out the Obvious Explanations
Naturally, researchers wanted to know what actually drove the inflammation drop. Total calorie intake did not change significantly in either group, which ruled out simple caloric restriction as the primary explanation. Similarly, physical activity levels, anxiety scores, and depression scores remained stable throughout the study period.
Interestingly, several other changes did emerge within the fasting group specifically. Body weight decreased significantly, daily cigarette consumption dropped, sleep duration shortened, and intake of polyunsaturated fatty acids fell notably. None of these shifts alone, according to the authors, fully accounted for the inflammation reduction observed.
Instead, the researchers point toward a more layered explanation. Ramadan fasting changes not just how much people eat, but when and how often. Meals shift from three smaller portions to typically two larger ones, timed around dawn and sunset. Prior research in other populations has linked exactly this kind of altered meal timing and frequency to improved insulin sensitivity and reduced inflammatory signaling, independent of total calories consumed.
How Did Eating Habits Change?
This table focuses on what people ate during the 2-week study period.
| What Was Measured | Fasting Group | Non-Fasting Group | Was the Difference Real? |
|---|---|---|---|
| Total Daily Calories | Went down slightly (1,357 → 1,249 calories) | Stayed about the same (1,220 → 1,249 calories) | ❌ NO (p=0.115) – Both ate about the same |
| Carbohydrates (% of diet) | Went up a little (59.5% → 62%) | Stayed about the same | ❌ NO (p=0.527) – No big change |
| Protein (% of diet) | Went down a little (14% → 13.1%) | Stayed about the same | ❌ NO (p=0.125) – No big change |
| Total Fat (% of diet) | Went down a little (26.4% → 24.1%) | Stayed about the same | ❌ NO (p=0.453) – No big change |
| Healthy Fats (PUFA) | Dropped from 11.2g to 7.8g | Stayed about the same (9.1g → 9.5g) | ✅ YES (p=0.029) – Fasters ate fewer healthy fats |
Why This Matters for Heart Health
This finding carries real weight beyond a single inflammation marker. People living with HIV, research consistently shows, face meaningfully higher cardiovascular disease risk than the general population, even when the virus itself remains well controlled through treatment. Persistent inflammation appears to be a key driver behind that elevated risk.
Elevated hs-CRP specifically has been linked in prior studies to higher rates of cardiovascular events, certain non-AIDS-related cancers, and other chronic complications among people living with HIV. Consequently, any safe, accessible intervention capable of lowering hs-CRP, even modestly, could theoretically translate into meaningful long-term benefit, particularly for a population managing lifelong treatment.
Furthermore, this study’s findings align with earlier fasting research in different populations. Similar hs-CRP reductions have appeared in studies of patients with metabolic syndrome and asthma. That consistency across different patient groups strengthens confidence that the pattern observed here reflects a genuine physiological response rather than a statistical fluke.
An Important Contrast Worth Noting
Not every past study on fasting and inflammation reached the same conclusion, however. One earlier study involving patients with schizophrenia actually found hs-CRP levels increased during Ramadan fasting rather than decreasing. Notably, that study lacked a control group and did not track participants’ caloric intake or physical activity, both factors that could plausibly explain the divergent result.
By contrast, the current study’s design specifically addressed those gaps, incorporating a matched control group alongside detailed dietary and lifestyle tracking. This methodological strength lends additional credibility to its findings, even given the study’s modest size.
Limitations the Researchers Acknowledge
To their credit, the study’s authors are transparent about its constraints. With only 29 participants in each group, the sample remains too small to draw sweeping conclusions applicable to all HIV patients. Larger studies would help confirm whether this effect holds consistently across broader, more diverse populations.
Additionally, blood samples were collected only twice, once before Ramadan and once during the fasting period. As a result, researchers cannot yet say whether the inflammation-lowering effect persists after Ramadan ends, or whether hs-CRP levels simply rebound once normal eating patterns resume. A third measurement point, taken after Ramadan concluded, would have helped answer that lingering question.
Moreover, the study did not exclude participants taking antioxidant supplements or those who continued smoking, both factors that could influence antioxidant status results independently of fasting itself. Future research designs could tighten these criteria for cleaner comparisons.
What Comes Next
Despite these limitations, this study marks a genuine first step. According to the authors, no previous research had examined Ramadan fasting’s effects specifically among HIV patients on antiretroviral therapy, making this a meaningful contribution to a largely unexplored area.
Looking ahead, larger and longer studies could help clarify several open questions. Does the inflammation benefit persist beyond the fasting month? Would results differ among women, older patients, or those newer to treatment? And precisely which combination of factors, whether meal timing, smoking reduction, or weight change, drives the effect most strongly?
For now, this research offers cautious, genuinely interesting news for the millions of Muslim patients living with HIV who choose to observe Ramadan fasting each year. Their religious practice, it turns out, may be doing quiet, measurable good for their long-term cardiovascular health, alongside its spiritual significance.
Reference: Widhani A, Yunihastuti E, Setiati S, Witjaksono F and Karjadi TH (2023) Ramadan fasting reduces high-sensitivity C-reactive protein among HIV-infected patients receiving antiretroviral therapy. Front. Nutr. 9:964797. doi: 10.3389/fnut.2022.964797
Other Articles:
