Japan could become one of the first countries in the world to end the HIV epidemic, says the president of Gilead Sciences Japan, Kennet Brysting. The idea for now could seem a little too ambitious, but it is not entirely unrealistic, given that the availability of medicines that can prevent transmission of HIV. Drugs are not the cure, but control over the spread of virus to the point where the disease is no longer a major public health threat.

What Is The Role Of Preventative HIV Medicines?

Gilead's have two key drugs, Truvada and lenacapavir. These two are playing a crucial role in prevention. Truvada is taken as a daily pill, while lenacapavir requires two injections per year. It can make the virus undetectable in infected individuals and prevent transmission to those who are not infected yet. In trials, lenacapavir showed 100% efficacy in preventing HIV infections. This is why it is describe as "almost a vaccine".

In 2024, Japan also approved Truvada for HIV prevention, but the country has yet to approve lenacapavir for the same. Until now, people in Japan had been importing generic versions of Truvada or purchasing it from clinics that source it from overseas.

HIV In Japan

Up until now, Japan reported around 25,000 HIV infections, whereas 669 new cases were reported in 2023. For seven consecutive years, the number of new infections remained under 1,000. The downward trend thus shows that the virus has been controlled, however, getting to zero new infections remains the ultimate goal.

Brysting too acknowledged that simply having effective drug is not enough. What is important is to have a proper implementation, access and healthcare support to make sure that these treatments are widely available and effective.

What Are The Challenges In Implementation?

The biggest challenges is testing rates. There is a need to increase testing rates. At this very moment, around 86% people infective with Japan have been tested, but the goal is to increase it up to 95%, with an ideal goal of 100%. Without widespread testing, many infected people may not even know that they are infected and it could transmit the virus.

Another measure issue is the cost of preventative medication. While Japan's health insurance covers treatments for diseases, it does not cover preventative drugs. Those who purchase Truvada for prevention, pay around $470 per month. Some clinics in Tokyo offer generic alternatives too, which is cheaper, but they are not ideal.

Better Healthcare Support

Brysting expressed concern that individuals importing medications might not be consulting doctors regularly, which is essential for monitoring HIV status and overall health. Truvada users need to be tested for HIV initially and every three months, along with screenings for other infections and kidney function checks. Without proper medical supervision, there is a risk of misuse and inadequate protection.

Gilead is in discussions with Japanese authorities to improve access and insurance coverage for Truvada, and progress is being made. Japan has shown efficiency in approving critical medicines, as seen during the COVID-19 pandemic when Gilead’s remdesivir was approved in just three days.

What Is The Way Ahead?

Gilead at this moment is not only focused on HIV and hepatitis C, but also expanding into oncology with innovative treatments like CAR-T cell therapy, which strengthens a patient's immune system to fight cancer.

However, Japan’s strict approval processes can slow down drug availability. Phase 3 clinical trials often need to be conducted within the country, and Japan tends to approve medicines much later than other regions. For instance, Truvada was approved for prevention in Japan 12 years after the U.S. and nearly 20 years after its approval for treatment. inancial factors also play a role. The Japanese government adjusts drug prices annually, often reducing them, which can make long-term investment challenging for pharmaceutical companies.

Weight loss drugs appeal to many for their convenience, but according to some experts, there are a number of noteworthy side effects. From rapid weight gain to sagging skin, several side effects of weight loss drugs have been identified through studies. Now, new research has found that weight loss drugs can cause more muscle loss than clinical expectations. The results, presented at the American College of Physicians Internal Medicine (ACP-IM) meeting in San Francisco, add to existing evidence on the possible adverse effects of GLP-1.

Why does muscle loss occur during weight loss?

When a person loses a considerable amount of weight, they also lose bone mass, muscle mass, and some connective tissue. Experts at the University of North Carolina at Chapel Hill found that no studies directly associate muscle loss with a decline in physical function or strength. However, this clinical gap underscores the need to assess strength and mobility alongside weight loss in patients receiving this therapy. The systematic review identified 36 randomised clinical trials that measured changes in muscle mass and fat among adults using incretin-based obesity medications such as tirzepatide, dulaglutide, or semaglutide.

Each study measured body composition using MRI, CT scans, and bioelectrical impedance analysis. Most of them used DEXA along with other methods to obtain information about lean muscle mass, bone mineral density, and the distribution of body fat. The average age of participants ranged from 20 to 63.7 years. Only four studies included participants aged 60 years and above. None of the studies focused on adults aged 65 years or older.

Average muscle loss on weight loss drugs

Researchers noted a concerning trend: patients’ estimated muscle loss exceeded the 25 per cent threshold. Clinicians had expected a 25 per cent reduction, but not more than that. Experts also found that 68 per cent of people who used the drugs exceeded the 25 per cent benchmark, compared to 50 per cent of those who relied on placebos and lifestyle interventions. None of the studies measured whether the loss of muscle mass was correlated with function or strength loss.

Muscle mass diminishes with age

Despite being a concerning side effect of weight loss drugs, muscle mass is likely to diminish anyway with age. Additionally, the loss is more significant in older adults. Therefore, doctors advise caution when prescribing these drugs to individuals who are more prone to losing muscle function at an advanced age. Ideally, doctors should recommend exercise or physical therapy to patients taking weight loss medications.

The final word

According to experts, weight loss drugs do have a positive side — and that extends beyond obesity treatment. These drugs are also beneficial for diabetes and help reduce the risk of cardiovascular disease. However, it is important to support treatment with the right kind of diet and a proper exercise regimen. Solely depending on the medication can lead to weight gain once it is discontinued. Therefore, for healthy weight loss, it is best to rely on sustainable methods for long-lasting results.

Indian guru and founder of the Isha Foundation, Sadhguru, offers a different perspective on life and mental health. In a 2025 talk, he spoke about weight loss. At a time when obesity, metabolic, and lifestyle disorders are at an all-time high, there is an urgent need to revisit and fix the way one eats. While many turn to diet fads and practise calorie or food group restrictions, Sadhguru recommends the contrary. The 68-year-old emphasises the importance of sustainable weight management through balanced choices, mindful eating and meals aligned with the body’s natural rhythm.

Sustainable approach to weight loss

Many people aim to lose weight to deal with body image issues or to prepare for a special upcoming occasion. However, according to Sadhguru, one must not try to force discipline through restriction, but instead allow the body to regulate itself efficiently while maintaining energy levels. If you are looking for foods to include in your diet for sustainable weight loss, here are some recommendations:

1. Plant-based diet: A plant-based diet is one of the most talked-about ways to lose weight sustainably. Nutritionists say that 30–40 per cent of the diet should consist of fruits, vegetables, whole grains and legumes. These foods are comparatively easier to digest and do not put much pressure on the digestive system, as opposed to heavy, non-vegetarian meals. This should be combined with a proper workout routine, as without movement, weight gain is likely to occur.
2. Eat millets: Millets such as ragi, bajra and jowar digest slowly. They have a low glycaemic index and do not cause sudden blood sugar fluctuations. A sudden rise and fall in energy levels can trigger sluggishness over time. Millets, on the other hand, release energy slowly, thereby keeping you active for longer and reducing frequent hunger pangs. Over time, you can reduce portion sizes to lose weight.
3. Occasional cleansing: During the talk, Sadhguru also emphasised the importance of periodic cleansing. Simple yet effective, periodic cleansing involves drinking a detox beverage such as ash gourd juice with a small amount of honey for one or two days a month. This acts as a gentle reset for the digestive system and helps the body feel refreshed and lighter. Over time, this can curb cravings and make fasting easier.
4. Sustainable rules: For weight loss, it is advisable to follow sustainable rules that are not too strict to maintain in the long run. For instance, fasting for long durations without giving your body enough time to adapt can lead to metabolic disorders over time and excessive hunger pangs. It is important to prioritise balance, awareness and nourishment.
5. Energy-boosting snacks: When hunger pangs occur, it is important not to turn to unhealthy snacks such as crisps, biscuits or tea cakes. Instead, for sustained energy, healthier snacks are recommended. Some of the best options include peanuts, berries, nuts and seeds. These will help you feel full and may even aid metabolism.
6. Time your meals: Timing your meals is equally important, as it gives the digestive system enough time to function. Ideally, there should be an eight-hour gap between meals. People who find this difficult can aim for a five- to six-hour interval instead. Frequent meals can place too much load on the digestive system, while infrequent meals can cause metabolic disturbances. Therefore, striking a balance is essential.

Eat healthy meals and follow a proper diet plan; your diet must be balanced—many have grown up listening to these healthy recommendations. However, little do we realise just how much difference healthy habits make to our lives. Even when it comes to constipation, one barely understands the long-term repercussions of irregular trips to the loo and how this may impact overall health. According to a 2023 review, prominent differences can be noticed in the gut microbiomes of 'slowpokes' and 'speeders.' Because the gut is strongly linked to overall health, there are several health implications that often go unnoticed.

What happens when you are constipated for a long time?

Constipation refers to a state wherein one fails to pass stools at least three times a week. Slow transit, too, is associated with inflammatory and metabolic disorders—and even Parkinson’s disease. Experts say that identifying microbiome profiles linked to gut transit time could help develop a fresh approach to treating and managing these conditions. Experts involved in the study explained how bidirectional interactions between transit time and gut microbiota provide a useful way to understand gut microbiome variations in both disease and health.

Why is the gut microbiome important?

Experts say that the gut microbiome, in both activity and composition, plays a crucial role in health. From diet to exercise, it can be shaped by various factors. For this, experts evaluated the impact of holding in stool and its consequent effects on health. They analysed previously published research on gut transit time, diet, gut microbiome composition, stool consistency, and metabolites released. Experts found that the studies involved thousands of participants—both healthy individuals and those dealing with comorbidities such as liver cirrhosis, irritable bowel syndrome and constipation. However, this required swallowable capsules with sensors to track their journey through the digestive tract.

Another method used was the Bristol Stool Scale—a diagnostic tool that classifies stool based on whether it resembles hard pellets or watery mush. Some studies also tracked how long participants took to pass sweetcorn or blue dye. The goal was the same — estimating how long food remains in the colon. The longer it stays, the more time bacteria have to regulate gut acidity, ferment components, and produce metabolites that influence overall health.

The nutrition link

The research team yielded interesting results — people with faster gut transit had different microbiomes compared to those with slower transit times. This helped provide better predictions for gut microbiota than a simple test alone. It was also found that faster gut transit times were associated with microbiomes dominated by faster-growing species that thrived on a low-fat, high-carbohydrate diet. Slower transit times, however, were linked to microbiomes influenced by diets high in protein. These extremes can reduce gut microbiome diversity compared to average transit times. Therefore, both fast and slow movement create environments where specific species dominate.

Collectively, the research showed that gut transit time is an overlooked tool for understanding how the gut functions, its role in overall health, and how people respond to treatments such as probiotics. This could also explain why the same gut health advice does not work for everyone. Two people can consume the same meal and still show different results, suggesting that an individual's gut rhythm can help tailor dietary advice and treatment to suit their body.

The research is published in the journal Gut.