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.

Low-dose CT (LDCT) screening of people at high risk based on age and smoking history can reduce lung cancer deaths and advanced-stage disease, according to an International Agency for Research on Cancer (IARC) working group.

Speaking to HealthandMe, Dr Abhishek Shankar of AIIMS New Delhi, the only Indian author among the 23 experts from 17 countries involved in the IARC review, said India needs to generate its own screening evidence.

The review was published in The New England Journal of Medicine as part of IARC WHO Handbook 21.

India Should Not Wait For A Perfect Model

Dr Shankar, a lung cancer specialist, said India needs to generate its own screening evidence while ensuring high-risk people have access to screening and follow-up care.

“India should not wait for a perfect screening model and there is a need to generate Indian evidence while ensuring that those at highest risk have access to lung cancer screening and care pathways for screen positive cases,” he said.

Dr Shankar is leading the Indian Lung Screening Trial (ILST), which is assessing risk-based lung cancer screening across 10 centers in India.

Also read: Never Smoked, Still Got Lung Cancer? Rare Gene Mutation Linked To Over 60x Risk

Who Should Undergo LDCT Screening?

The evidence mainly covers people aged 50 to 80 with a substantial smoking history, typically 20–30 pack-years or more. Studies involving former smokers generally included those who had quit within the previous 10–15 years.

In India, people aged 50 to 80 who have smoked at least 20 pack-years and are current smokers or quit within the past 15 years can contact ILST about screening under the trial.

“High-risk smokers should be encouraged to participate in organized screening rather than opportunistic CT scanning, with appropriate nodule management, follow-up and smoking-cessation support,” Dr Shankar said.

What Did The Trials Show?

Read More: World Lung Day: Dry Cough, Breathlessness May Not Always Be Asthma — Could It Be ILD?

In the US National Lung Screening Trial, LDCT was linked to a 16% lower relative risk of lung cancer death at seven years compared with chest X-rays. The European NELSON trial also found lower lung cancer mortality among men screened with LDCT at 10 years.

IARC classified LDCT as Group A, indicating established evidence that it reduces lung cancer mortality and stage III or IV disease. Chest X-rays, with or without sputum examination, were classified as Group C, as a mortality benefit could not be established.

What Are The Risks Of LDCT Screening?

LDCT is not meant for everyone. Across studies, false-positive rates ranged from 1% to 42%. Among those with false-positive results, 5% to 32% underwent an invasive procedure, with complications reported in 10% to 22% of those procedures.

The review also estimated that 3% to 26% of lung cancers detected in randomized trials could represent over-diagnosis.

The IARC group stressed that screening requires more than CT scans, including risk assessment, nodule management, follow-up, smoking-cessation support and adequate healthcare capacity.

“India has an opportunity to build an equitable, affordable, locally relevant lung cancer screening pathway and ILST can provide the evidence needed to guide that future,” Dr Shankar said.

Doctors may soon be able to determine a brain tumour’s type right during the surgery. Doctors remove a tissue sample during surgery to analyse the tumour. Patients undergoing surgery for brain tumour may not have to wait days or weeks to find out.

A new rapid genetic test being tested by the NHS in England promises to shorten the wait time drastically. The technology can find the precise type of brain tumour within about two hours, while the patient is still on the operating table.

Developed by researchers at the University of Nottingham and Nottingham University Hospitals NHS Trust, the test analyses the genetic code of a tumour sample rather than relying only on traditional microscopic examination.

Brain Tumour Diagnosis Takes A Long Time

Brain tumours are not connected to one single disease. There are more than 100 types, ranging from relatively slow-growing tumours to highly aggressive cancers. Knowing the exact type and characteristics of a tumour is important because treatment courses can differ significantly.

Traditionally, doctors take a sample during surgery and send it to a pathology laboratory. The tissue sample is then examined under a microscope. Finding out the tumour type usually takes weeks.

According to an NHS centre, the current average time for a brain tumour diagnosis can be around 26 days, while other reports have estimated up to almost eight weeks in some cases. In case of aggressive tumours, waiting period can be particularly difficult and longer.

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More About The New Test

The rapid genomic test works by analysing a small piece of the tumour which is taken during the surgery and sent to the laboratory, where its DNA is analysed using a shoebox-sized sequencing machine developed by Oxford Nanopore.

Inside the machine, DNA molecules pass through tiny pores. As they move through, the system reads their genetic information and uses the resulting genomic pattern to identify the tumour type.

Marking a significant jump in speed and time taken, the test can help doctors can receive detailed diagnosis during the operation itself instead of weeks.

Also read: Radiotherapy Cuts Risk Of Atypical Meningioma Recurrence By Nearly Half: Lancet Study

Promising Development In Brain Tumour Diagnosis

Not only this test reduces weeks, sometimes months of anxiety, it can also help surgeons make immediate decisions about how much tumour tissue to remove while protecting healthy brain tissue.

Some tumour types require different surgical approaches, and having molecular information immediately could help the surgeon take quick decisions.

A rapid diagnosis can also help patients to begin the appropriate treatment sooner and gain earlier access to clinical trials designed for specific tumour types.

The NHS is piloting the technology to determine how well rapid genomic testing works in routine clinical practice. The initial rollout covers five specialist centres, including Nottingham University Hospitals, University Hospitals Birmingham, Great Ormond Street Hospital, King's College Hospital and Newcastle Hospitals. More centres are expected to be added soon.

The rapid testing is therefore intended to complement the entire diagnostic process rather than make traditional pathology obsolete. If the NHS pilot is successful, rapid genomic testing could eventually make that information available much earlier to brain tumour patients across England.

The early signs of type 2 diabetes could be related to your gut. They may signal a warning risk long before you take a blood sugar test.

New research suggests that changes in the trillions of bacteria living in the gut may accurately predict future diabetes risk.

An analysis of microbiome data from more than 229,000 adults in the UK and US identified hundreds of bacterial changes linked with type 2 diabetes, including changes that appeared before measurable abnormalities in blood glucose.

The findings are being presented at the annual meeting of the European Association for the Study of Diabetes (EASD) in Milan.

What Did Researchers Find?

Researchers from the University of Trento in Italy and collaborators in the UK analysed metagenomic data, which involves examining the DNA of microorganisms living in the gut.

The study included 229,025 people, of whom 3,627 had type 2 diabetes, 14,022 had prediabetes and 211,376 had normal blood glucose levels. The average age was 50, and about 74% of participants were women.

After accounting for factors including age, sex and body mass index, researchers identified 789 bacterial species associated with type 2 diabetes.

Of these, 168 were found at higher levels in people with diabetes, while 621 were present at lower levels.

One example was Enterocloster bolteae, which was more abundant in people with type 2 diabetes. In contrast, Romboutsia timonensis was found at lower levels.

Interestingly, 587 of the 789 bacterial species were also associated with unmedicated prediabetes, suggesting that some of these microbial changes may occur before diabetes is diagnosed.

Also read: Diabetes Linked To 55% Risk Of Kidney Disease, Heart Failure Or Death Within 10 Years: Study

Link Between Gut & Blood Sugar

The researchers looked at 135,093 people who had normal blood glucose and did not have diabetes or prediabetes. They also had information about how their blood sugar responded after eating.

Normally, blood glucose rises after a meal and then falls. If it remains elevated for longer than expected, it can indicate that the body's muscles are not responding properly to insulin, an early feature of insulin resistance.

Researchers found that people whose blood sugar remained elevated for longer were more likely to have the gut bacterial pattern linked with type 2 diabetes. The microbiome changes became more pronounced as insulin resistance increased.

Therefore, it was observed that the gut microbiome carried clues about metabolic problems even when standard blood glucose levels were still normal.

Also read: Muscle Loss In Middle Age May Signal Dementia Risk, Study Finds

Future Of Diabetes Testing

Currently, diabetes and prediabetes are diagnosed using tests like HbA1c, fasting blood glucose and oral glucose tolerance tests.

For people who have normal results, doctors generally assess future diabetes risk using factors like age, sex, body mass index and family history. A gut microbiome test is not currently part of routine diabetes screening.

The researchers believe microbiome analysis could eventually provide an additional layer of risk assessment, identifying people who could benefit from earlier lifestyle interventions.

Professor Tim Spector, one of the study's authors, Scientific Co-Founder, ZOE, said, “These latest findings represent a major step forward in understanding how our gut microbiome is linked directly with metabolic disease. Identifying these clear microbial changes before blood sugar levels worsen could lead to earlier intervention with food and lifestyle choices, as well as treatment options, to prevent T2D."

The researchers say that microbiome analysis should not replace existing tests for diabetes or prediabetes. The current findings show associations between particular bacterial patterns and diabetes risk.

The researchers also found that some of the bacteria making up the diabetes-related signature have never been isolated or cultivated in a laboratory and are new in terms of scientific investigation.

Additional research will be needed to assess whether these microbial changes can reliably predict who will develop diabetes and whether changing the microbiome can actually reduce that risk.