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.

The sudden collapse and death of a nine-year-old girl inside her classroom in Delhi has raised concerns about cardiac emergencies in children. The Class 3 student had reportedly returned to the classroom after a games period and collapsed shortly afterwards.

CCTV footage showed her walking into the classroom, placing both hands around her waist and then falling to the floor. A teacher rushed to help her and attempted to revive her before seeking further assistance. School staff took the child to a nearby hospital, which reportedly did not admit her. She was subsequently taken to another hospital in Nirman Vihar, where doctors declared her dead.

Speaking to HealthandMe, Dr Neeraj Awasthy, Senior Director, Pediatric Cardiology, Fortis Hospital, Okhla, said heart attacks in children are extremely rare and differ from those commonly seen in adults.

"In adults, a heart attack is usually caused by a blockage in the arteries supplying the heart. In children, sudden cardiac arrest is more often associated with an underlying heart condition, such as a structural abnormality, an inherited problem affecting the heart rhythm or inflammation of the heart muscle," he said.

Dr Awasthy also explained the possible causes and warning signs of cardiac events in children.

What Causes Sudden Cardiac Events In Children?

Also read: Energy Drinks Linked To More Heart Problems In Young Adults: Study Flags Cardiac Risks

According to Dr Awasthy, sudden cardiac arrest in children is more commonly associated with underlying heart conditions, including:

• Structural abnormalities of the heart.
• Inherited conditions affecting the heart rhythm.
• Inflammation of the heart muscle.

Does Genetics Contribute To Sudden Cardiac Death?

In a post on X, Vinod Scaria, a scientist, said nearly one in five sudden cardiac deaths in young people may have a definite genetic explanation.

Three groups of inherited conditions account for much of this genetic risk:

• Cardiac channelopathies.
• Cardiomyopathies.
• Familial hypercholesterolaemia.

Scaria cited an analysis of Indian genomes that found variants associated with channelopathies in approximately 1% of individuals, cardiomyopathies in more than 1.5% and familial hypercholesterolaemia in about one in 150 individuals.

Read More: Spanish Striker Jesus De Miguel Dies After On-Field Collision: Can A Blow To The Chest Trigger Cardiac Arrest?

What Warning Signs Should Parents Watch For?

Dr Awasthy told HealthandMe the following symptoms should not be ignored:

• Fainting during physical activity.
• Unexplained chest pain.
• Breathlessness.
• A racing heartbeat.

Why Does Genetic Screening Of Families Matter?

Scaria highlighted the importance of investigating possible genetic causes after sudden cardiac death in a young person.

A molecular autopsy can identify genetic causes that a conventional autopsy may miss. Since many of these conditions are inherited in an autosomal dominant manner, up to half of first-degree relatives could carry the same genetic variant and share the risk.

People with a family history of unexplained sudden death or inherited heart disease should seek genetic counselling. Others in high-risk occupations may also benefit from an individual risk assessment.

What To Do If A Child Collapses

Dr Awasthy said immediate cardiopulmonary resuscitation (CPR) and access to an automated external defibrillator (AED) can be life-saving if a child collapses and is unresponsive or not breathing normally.

An experimental gene therapy has shown tremendous potential in reducing the frequency of seizures in three patients with drug-resistant epilepsy.

The results have raised hopes for a new approach to treating epilepsy patients who do not respond to conventional anti-seizure medications.

All three participants experienced a reduction of more than 90% in their monthly seizure frequency after the treatment. No serious side effects were reported during the study.

The results were reported today in The New England Journal of Medicine by Yang Dai, a neurosurgeon at Xuanwu Hospital of Capital Medical University in Beijing, and his colleagues.

“It’s exciting that there’s such a dramatic effect, and that they see very few side effects,” says Matthew Walker, a neurologist at University College London who was not associated with the study.

How Does the Experimental Gene Therapy Work?

Also read: TV Actor Anuj Thakur Dies At 33 After Suffering A Seizure In His Sleep: When Can Nocturnal Seizures Turn Fatal

The treatment uses a modified virus called adeno-associated virus 9 (AAV9) to deliver genetic instructions directly into the part of the brain from where seizures stem.

The virus carries a gene that instructs specific neurons, known as excitatory neurons, to produce a receptor that are sensitive to a particular medication.

Once the gene is delivered, patients take clozapine, which is an antipsychotic medication. The drug activates the receptors, reducing the activity of the neurons and helping suppress the electrical signals that cause seizures.

Researchers describe the medication as a kind of dimmer switch because it allows them to adjust the activity of the genetically modified brain cells.

Unlike conventional gene therapies, this approach gives researchers a way to regulate the treatment using medication.

What Did The Clinical Trial Find?

Also read: Woman With Epilepsy Dies After Following ChatGPT’s Advice To Stop Medication: Why AI Cannot Replace A Doctor

The study was led by neurosurgeon Yang Dai of Xuanwu Hospital, Capital Medical University, in Beijing.

It involved three adults with drug-resistant epilepsy caused by hippocampal sclerosis, a condition in which scarring develops in the hippocampus, a brain region involved in memory and seizure activity.

All three participants had experienced epilepsy for 10 to 25 years. Despite trying at least two anti-seizure medications, their seizures still remained out of control.

They also experienced at least two seizures per month on average during the three months before entering the trial.

After gene therapy all three participants saw a reduction of more than 90% in their monthly seizure frequency.

Significant Discovery For People With Drug-Resistant Epilepsy

Also read: Can ChatGPT Replace Your Doctor? Why Epilepsy Patients Should Never Alter Medication on AI Advice

Epilepsy is a neurological disorder characterised by recurrent seizures caused by abnormal electrical activity in the brain.

Anti-seizure medications can help many people control their seizures. However, some patients continue to experience seizures despite trying multiple medications.

This is known as drug-resistant epilepsy. According to the International League Against Epilepsy, it generally refers to a failure to achieve control of seizure after sufficient trials of two anti-seizure medications.

Surgery may be an option for patients with focal epilepsy if doctors can identify the brain region responsible for seizures.

Limitations Of The Study

The new gene therapy takes a different approach by targeting the neurons responsible for seizures.

However, experts have raised concerns about the long-term use of clozapine. High doses of the drug have been associated with cardiovascular complications and other adverse effects.

Despite the reduction in seizures, researchers have warned against interpreting the findings as proof that the treatment is effective for all people with epilepsy.

The trial involved only three participants, making it too small to probe the treatment’s long-term safety or effectiveness.

All three also had a specific form of epilepsy related to hippocampal scarring on one side of the brain. The findings cannot automatically be applied to people with other forms of epilepsy or seizures originating in different brain regions.

More than a quarter of Americans (28%) misrepresented symptoms to obtain antibiotics for themselves, while 27% did so to get antibiotics for a child in their care, according to an alarming survey.

The nationwide survey of nearly 1,000 people, published in JAMA Network Open, found that common reasons included feeling very sick, believing antibiotics were the only effective treatment and needing to recover quickly to return to work or school.

The findings highlight the need for better communication between doctors and patients so that concerns are heard and symptoms are appropriately treated, whether or not antibiotics are needed.

“Now that we have a clearer picture of how common these behaviors are and the reasons behind them, the next step is to look at strategies that help patients express their preferences and communicate what they’re feeling to their provider, and for their provider to hear them, understand their concerns, and reassure them,” said Alistair Thorpe, research assistant professor of population health sciences at the University of Utah Health and one of the study's first authors.

What Did The Survey Reveal?

Also read: AI-Created Virus Injected Into A Human For The First Time To Fight Antibiotic Resistance

Among respondents, 28% said they had deliberately exaggerated or fabricated symptoms to obtain antibiotics for themselves, while 27% had done so for a child in their care.

The most common reason was feeling that they or their child were very sick and believing antibiotics were the only treatment that could help.

“It is a tough situation,” Thorpe said. “People are experiencing unpleasant symptoms, and they can have this strong feeling that antibiotics are the only thing that can help them feel better. Being told to just rest and wait is a hard thing to do, and if you think there’s something that could make you feel better, it’s a very hard impulse to override.”

Other reasons included needing to recover quickly to return to work or school and wanting greater control over treatment decisions.

Why Is Taking Unnecessary Antibiotics Dangerous?

Antibiotics treat bacterial infections but do not work against viral infections, which commonly cause cold- and flu-like symptoms. They can also cause side effects.

“These medications are not totally benign for the patient,” explained Andrea Levy, Professor of social sciences at Connecticut State Community College Middlesex and one of the study's first authors. “And antibiotic use contributes to increasing antimicrobial resistance, which is a broader public health concern.”

Unnecessary antibiotic use contributes to antimicrobial resistance (AMR), making bacterial infections harder to treat.

Accurate symptom reporting is therefore important. Doctors need a clear picture of a patient's symptoms to determine whether antibiotics are necessary and avoid prescribing them when they are unlikely to help.

Read More: 98 Years After Penicillin: Are We Running Out Of Effective Antibiotics?

Why Are Children At High Risk With Antibiotic Misuse?

Children commonly receive antibiotics for infections such as ear infections and respiratory illnesses. However, many childhood infections are caused by viruses, against which antibiotics are ineffective.

Unnecessary antibiotic exposure can cause side effects, including diarrhoea, nausea and allergic reactions. It can also contribute to antimicrobial resistance, making future bacterial infections harder to treat.

Repeated antibiotic use may also disrupt the developing gut microbiome, which plays a role in digestion and immune function.

Why Do Patients Misrepresent Symptoms And How Can It Be Prevented?

The researchers emphasise that the findings are not intended to blame patients or caregivers.

“There are very understandable reasons that we can sympathize with about why patients might feel the need to misrepresent symptoms, or why caregivers might do so on behalf of their children,” Levy said. “We’re simply saying: perhaps there’s a better way.”

Past experiences with healthcare providers may influence these decisions. People were more likely to exaggerate symptoms if a doctor had previously dismissed or downplayed their concerns.

Another factor is the mistaken belief that antibiotics helped someone recover from an earlier viral infection. Since viral infections usually resolve on their own, patients may incorrectly attribute their recovery to antibiotics rather than the body's natural healing process, Thorpe explained.

The findings highlight the need for better communication between doctors and patients.

Healthcare providers need to reassure patients that their symptoms are being heard and taken seriously, even when antibiotics are not appropriate.