Can HIV-Infected Patients Fast During the Month of Ramadan?

To the Editor:

Turkish physicians find themselves presented with special health care challenges during Ramadan. For this month, drinking and eating are limited to the hour before sunrise and the hour after sunset. Muslims who are ill are exempted from these regulations according to the Holy Book Qur’an, but many HIV-infected patients are reluctant to give up fasting and studies have indicated that this practice can have important implications for this patient population. A study conducted by Karaagaoglu, et al, ¹ showed that daily energy intakes were less than expenditures during the month of Ramadan. This condition can lead to impaired performance status and weight loss. In particular, they found insufficient calcium intake in fasting individuals, and as decreased bone density has been found in patients on highly active antiretroviral therapy, fasting has the potential to aggravate this condition.

In addition, it is well documented that the metabolism of some drugs is affected by food consumption. Thus, fasting could effect the efficacy of regimens including indinavir and didanosine, among others.

In a study of 100 healthy volunteers during the month of Ramadan in 2 successive years, Kadri et al. ² found anxiety increased during the 1st and 4th weeks of Ramadan, reaching a peak level at the end of the month. This anxiety could be intensified in HIV-infected patients, who are already at a heightened risk for anxiety disorders.

Conversely, fasting may have beneficial effects as well. Antiretroviral drugs come with the potential adverse effects of hypertriglyceridemia and hyper-cholesterolemia. Akanjio et al. ³ reported increased serum apo-1 and its ratio to apo B and HDL in stable hyperlipidemic subjects after Ramadan.

In conclusion, well-designed clinical trials in HIV-infected Muslim populations could test these hypotheses further and impact treatment modalities.

Gülay Sain Güven, MD