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World J Exp Med. Nov 20, 2021; 11(5): 66-78
Published online Nov 20, 2021. doi: 10.5493/wjem.v11.i5.66
Potential role of intermittent fasting on decreasing cardiovascular disease in human immunodeficiency virus patients receiving antiretroviral therapy
Martin Gnoni, Renato Beas, Anupama Raghuram, Celeste Díaz-Pardavé, Adrian Riva-Moscoso, Fortunato S Príncipe-Meneses, Raúl Vásquez-Garagatti
Martin Gnoni, Department of Internal Medicine, Good Samaritan Hospital, Cincinnati, OH 45220, United States
Martin Gnoni, Anupama Raghuram, Division of Infectious Diseases, Department of Medicine, University of Louisville Health Sciences Center, Louisville, KY 40202, United States
Renato Beas, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, United States
Anupama Raghuram, US Medical Affairs, Merck Research Laboratories, Kenilworth, NJ 07033, United States
Celeste Díaz-Pardavé, Adrian Riva-Moscoso, Fortunato S Príncipe-Meneses, Division of Research and Academic Affairs, Larkin Health System, South Miami, FL 33143, United States
Celeste Díaz-Pardavé, School of Medicine, Universidad Científica del Sur, Lima 15837, Peru
Adrian Riva-Moscoso, Fortunato S Príncipe-Meneses, Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
Adrian Riva-Moscoso, Fortunato S Príncipe-Meneses, Sociedad Científica de Estudiantes de Medicina, Universidad Peruana de Ciencias Aplicadas (UPC), Lima 15067, Peru
Raúl Vásquez-Garagatti, Hospital Medicine Department and Infectious Diseases, University of Tennessee Medical Center at Knoxville, Knoxville, TN 37920, United States
Raúl Vásquez-Garagatti, Department of Internal Medicine, Cherokee Health, Knoxville, TN 37921, United States
Author contributions: Gnoni M and Raghuram M contributed to study conception and design; Gnoni M, Beas R, Raghuram A, Díaz-Paradavé C, Riva-Moscoso A, Príncipe-Meneses FS and Vásquez-Garagatti R designed the outline and coordinated the writing of the paper; all authors wrote the original manuscript and assisted in editing; Gnoni M, Riva-Moscoso A, Príncipe-Meneses FS, Beas R and Díaz-Paradavé C prepared the figures; Gnoni M and Vásquez-Garagatti R supervised the majority of the writing and provided critical reviews.
Conflict-of-interest statement: The authors declare that there is no conflict of interest
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Adrian Riva-Moscoso, BSc, MS, Research Fellow, Division of Research and Academic Affairs, Larkin Health System, 7032 SW 62nd Avenue, South Miami, FL 33143, United States. rivamoscosoadrian@gmail.com
Received: April 11, 2021
Peer-review started: April 11, 2021
First decision: July 27, 2021
Revised: August 18, 2021
Accepted: September 23, 2021
Article in press: September 23, 2021
Published online: November 20, 2021
Abstract

Cardiovascular disease (CVD) has become one of the commonest causes of comorbidity and mortality among People living with human immunodeficiency virus (HIV) (PLWH) on antiretroviral therapy (ART). Nearly 50% of PLWH are likely to have an increased risk of developing CVD, including coronary heart disease, cerebrovascular disease, peripheral artery disease and aortic atherosclerosis. Aside from the common risk factors, HIV infection itself and side effects of antiretroviral therapy contribute to the pathophysiology of this entity. Potential non-pharmacological therapies are currently being tested worldwide for this purpose, including eating patterns such as Intermittent fasting (IF). IF is a widespread practice gaining high level of interest in the scientific community due to its potential benefits such as improvement in serum lipids and lipoproteins, blood pressure (BP), platelet-derived growth factor AB, systemic inflammation, and carotid artery intima-media thickness among others cardiovascular benefits. This review will focus on exploring the potential role of intermittent fasting as a non-pharmacological and cost-effective strategy in decreasing the burden of cardiovascular diseases among HIV patients on ART due to its intrinsic properties improving the main cardiovascular risk factors and modulating inflammatory pathways related to endothelial dysfunction, lipid peroxidation and aging. Intermittent fasting regimens need to be tested in clinical trials as an important, cost-effective, and revolutionary coadjutant of ART in the fight against the increased prevalence of cardiovascular disease in PLWH.

Keywords: Human immunodeficiency virus, Intermittent fasting, Antiretroviral therapy, Metabolism, Cardiovascular disease, Mortality and morbidity

Core Tip: Intermittent Fasting of 14-18 h/d (Time Restrictive Feeding) or 2 d fast/5 d fed (Alternate d Fasting) is a widespread practice that has aroused great interest in the scientific community. Many reviews have postulated the potential benefits of intermittent fasting in different diseases. It has been shown to improve weight loss, cardiovascular effects, and glucose metabolism. It consists of periods of strict caloric restriction alternating with variable feeding schedules. Hence, we aimed to present the first literature review regarding the role of intermittent fasting as a potential nonpharmacological and cost-effective strategy in decreasing the burden of cardiovascular disease among human immunodeficiency virus patients on antiretroviral therapy.