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.

Pancreatic cancer is one of the most painful forms of tumour and is also likely to become the second-leading cause of cancer-related deaths in the US by 2030. This could be because 85 per cent of cancer cases in the US are not diagnosed until the disease has spread. Pancreatic cancer is a disease that is usually diagnosed at an advanced stage because there are no prominent early signs. However, a newly developed AI model from the Mayo Clinic and the University of Texas MD Anderson Cancer Center could change that—a new CT scan-based system can help with the timely diagnosis of pancreatic cancer.

Can AI help with pancreatic cancer diagnosis?

REDMOD (radiomics-based early detection model) was tested on CT scans of patients who were later diagnosed with pancreatic cancer. Researchers found that in nearly three out of four cases, REDMOD successfully identified the most common form of pancreatic cancer 16 months before diagnosis. It nearly doubled the detection rate of specialists reviewing scans without AI assistance. In some cases, REDMOD recognised suspicious tissue patterns more than two years before diagnosis. Researchers said that the AI system can detect cancer up to three years in advance.

How does AI work for pancreatic cancer diagnosis?

Experts found that the greatest barrier to saving lives from pancreatic cancer was the inability to detect the tumour when it was still curable. AI can identify cancer signs from a normal-looking pancreas, and it can do so reliably across clinical settings. Researchers used 969 CT scans of the pancreas as training data for REDMOD to help it detect early-stage cancer signs.

Instead of looking for a prominent tumour, the model analysed radiomic patterns that disrupt tissue structure and texture—changes that are too subtle for the human eye to detect. Many cancers begin when normal cells acquire DNA mutations, which affect how cells divide and grow. However, it can take years before these changes develop into a tumour that produces symptoms or becomes clearly visible on a scan.

How accurate was REDMOD at diagnosing pancreatic cancer?

REDMOD was tested on a varied set of CT scans after training — 63 from patients who later developed cancer but were scanned before diagnosis, and 430 from healthy individuals. Out of the 63 cases, REDMOD flagged 46 as suspicious, resulting in a 73 per cent success rate. All these scans had previously been given the all-clear by radiologists who evaluated them at the same time as REDMOD.

Out of the 430 healthy individuals, 81 were identified as suspicious cases by REDMOD. This means that if AI were deployed in a real-world scenario, some individuals might be recommended for additional tests before receiving a final all-clear. A similar performance was observed in two other datasets from different hospitals using different equipment. For patients who had multiple scans available, AI produced consistent results, even when the scans were taken months apart.

Are there any drawbacks of REDMOD?

The sooner REDMOD is implemented in clinical practice, the earlier it can detect pancreatic cancer. It could identify tumours at a stage when treatment is still possible. This could significantly improve survival rates and reduce cancer-related mortality. However, researchers now aim to test the effectiveness of AI in larger and more diverse populations.

The research has been published in the Gut.

Eleven forms of cancer are becoming increasingly common among young people in England. Experts at the Institute of Cancer Research and Imperial College London stressed that cancer among younger people is still rare, and that everyone can reduce their risk by simply switching to a healthier lifestyle. However, why tumours have started to develop in people in their late teens, or in their 20s, 30s and 40s, remains unclear. The study further shows that the reasons behind rising cancer cases are elusive. However, this research does indicate a decade-long pattern of people becoming overweight.

Why does one develop cancer?

A team of scientists worked towards understanding why a person develops cancer. They examined national trends in lifestyle and cancer to identify patterns. Researchers found that cases of the following types of cancer were rising:

1. Liver
2. Kidney
3. Thyroid
4. Bowel
5. Multiple myeloma
6. Womb lining
7. Mouth
8. Ovarian
9. Breast
10. Gallbladder
11. Pancreatic

Researchers found that breast and bowel cancers are common among younger adults, with 11,500 cases in a year, while gallbladder and pancreatic cancers were much rarer. It was also noted that ovarian and bowel cancers were exclusively being reported in young people, whereas the other nine were increasing in adults as well. The study by the Institute of Cancer Research and Imperial College London also analysed behavioural patterns known to raise cancer risk.

Researchers also found patterns related to alcohol intake, smoking levels, red and processed meat consumption, and diets low in fibre. These factors play a role in cancer development, but do not conclusively explain why cancer rates are increasing. Century-old tumour patterns, however, may explain why younger people are getting bowel cancer.

How to check for bowel cancer risk?

The report suggested that the only factors that align with an increased risk of cancer are obesity and being overweight, both of which have been on the rise since the 1990s. Extra fat tissue can alter hormones such as insulin, which can increase cancer risk. For instance, in the case of bowel cancer, for every 100 extra cases, 20 could be attributed to excess weight, while 80 remain unexplained. Researchers also note that it is important to prevent all cancers, not just the additional cases. It is estimated that nearly 40 per cent of cancers worldwide can be prevented through appropriate lifestyle choices, such as quitting smoking.

How to reduce cancer risk?

Quitting smoking and avoiding alcohol are among the simplest and most well-known ways of reducing cancer risk. However, experts say that other measures can also help. Maintaining a healthy body weight and staying physically active are simple ways to reduce cancer risk. Researchers also emphasise that while cancer rates are rising among younger people, the risk of tumours remains significantly higher in older age groups.

Researchers found that one in 1,000 people aged 20, 30 and 40 are diagnosed with cancer every year, compared to one in 100 among older age groups aged 50, 60 and 70. The search for other risk factors continues. Inflammation, sweetened drinks, gut bacteria, and air pollution must be addressed in time to reduce cancer risk. It is also being investigated whether improvements in cancer detection are contributing to earlier diagnoses in younger individuals.

The study’s findings are published in the BMJ Oncology.

Cervical cancer is a slow-developing cancer that occurs in the lower part of the uterus. It is caused by a persistent HPV infection, which usually occurs in women in their prime. Some of the symptoms of cervical cancer include pelvic pain and abnormal bleeding. Experts say that timely detection through a Pap smear or prevention with an HPV vaccine can make a difference. However, according to a study published in The Lancet, high-income countries are on the right track to eliminate cervical cancer.

What causes cervical cancer?

The study published in The Lancet notes that high-income countries are on the right track towards cervical cancer prevention through vaccination and screening. By 2048, low- and middle-income countries will see only slight reductions over the next century. As a result, the gap between regions will likely widen dramatically. Experts have found that 99 per cent of cervical cancer cases are linked to infection with human papillomaviruses (HPV), a virus that is transmitted through sexual contact.

Preventing cervical cancer

Cervical cancer, according to experts, can be prevented through the HPV vaccine and regular screenings. The elimination target set by the World Health Organization is fewer than four cases per one lakh women. Every country, as per the WHO, must meet the ‘90-70-90’ targets by 2030. This means 90 per cent HPV vaccine coverage among girls by the age of 15, 70 per cent of women screened between the ages of 35 and 45, and 90 per cent of women with pre-cancer and cancer treated. This would be considered being on track for cervical cancer elimination in the coming century.

Researchers note that reaching the WHO targets for screening and vaccination, for HPV elimination, or for introducing universal vaccination with high coverage, is essential for the elimination of cervical cancer. This could help bridge global inequalities in disease management. Achieving the 90-70-90 goal can avert 37 million cancer cases by the next century, thereby accelerating progress in eliminating the disease. The model, however, suggests that most countries are unlikely to reach the target without increasing investments in this direction.

The research model

Researchers proposed five HPV-centric prevention strategies. Under a status quo model, cervical cancer incidence could decline by 23 per cent, consequently leading to inequalities in disease management. Experts found that achieving 90 per cent vaccination coverage in low- and middle-income countries would reduce inequalities and help eliminate cancer. Research authors also noted that recent advancements, such as single-dose vaccines at a lower cost, could accelerate cervical cancer elimination worldwide.

Global efforts from international agencies and governments are also important. A September 2022 study published in The Lancet Oncology found that a single-dose cervical cancer vaccine with lasting protection and 90 per cent coverage could prevent 78 per cent of cancer cases in India.