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 new breast cancer screening guidelines released by the American College of Physicians (ACP) call for mammography screening once every two years in asymptomatic, average-risk adult females, instead of the annual recommendation.

ACP is the largest medical specialty organization in the United States with members in more than 172 countries worldwide.

The guidance statement was developed by ACP's Clinical Guidelines Committee, which defined average risk as females

• who do not have a personal history of breast cancer or a diagnosis of a high-risk breast lesion,
• a genetic mutation such as BRCA 1 or 2 that is known to increase risk,
• another familial breast cancer risk syndrome,
• a history of high-dose radiation therapy to the chest at a young age.

While the annual mammography has long been considered the standard, in a paper published in Annals of Internal Medicine, the ACP authors explained that the changes have been made to tackle the harms caused by false positive results and the resulting psychological distress.

The false positive results can lead to "overdiagnosis, overtreatment, additional testing, and radiation exposure, and may outweigh the uncertain benefits in this population,” said the ACP.

Also read: Breast Cancer Screening: AI May Predict Tumors Before Mammograms Can Detect Them

Mammography For Breast Cancer: What Did The Guidelines Say

• The ACP stated that all average-risk females ages 50 to 74 should receive biennial screening mammography for breast cancer.

• It urged females between the ages of 40 and 49 to discuss with their doctor their risk for breast cancer and the benefits and harms of screening.

• The guidelines stated that asymptomatic, average-risk females who are 75 years or older, or those with a limited life expectancy, can discuss stopping routine screening with their doctor.

"This is because the benefits of screening beyond age 74 are reduced or uncertain, while potential harms, such as overdiagnosis, become more likely with increasing age," it said.

• Further, for asymptomatic, average-risk females who have dense breasts, ACP advises doctors to consider supplemental digital breast tomosynthesis (DBT).

"Decisions should consider potential benefits and harms, radiation exposure, availability, patient values and preferences, and cost," the ACP said, while advising against using supplemental MRI or ultrasound for screening in this population.

Why Experts Are Disagreeing

Breast cancer is one of the leading causes of death in 40–49-year-old women in the United States, and screening is specifically performed to prevent death from breast cancer.

Screening only women ages 50-74 every other year – as called for by ACP – may result in up to 10,000 additional, and unnecessary, breast cancer deaths in the United States each year, said the American College of Radiology (ACR) and the Society of Breast Imaging (SBI) in a joint statement.

Also read: What's The Confusion! Why Most Women Don’t Know When To Start Mammogram Screenings?

Calling the new guidelines “outdated and hyperbolic information”, the statement noted that it will cause continued confusion among women.

"Thousands more women would endure extensive surgery, mastectomies, and chemotherapy for advanced cancers than if their cancers were found early by an annual mammogram,” it said.

Current guidelines from the ACR and the SBI urge women to start annual screening at age 40.

The ACR also recommends that women have a breast cancer risk assessment by age 25. Those at higher risk for breast cancer should talk to their doctor about starting screening before age 40 and additional screening methods -- particularly those with genetic mutations or a strong family history of breast cancer.

The United States Preventive Services Task Force (USPSTF) also urges starting annual screening at age 40 to save lives.

Further, the statement also called out ACP for its failure to recommend exams beyond digital breast tomosynthesis (DBT) for screening women with dense breasts. The statement said this "is also out of step with current research, which shows the need to go beyond DBT to help find cancer in these women".

Three cases of meningitis have been reported among schoolchildren in the Weymouth area in the UK, health officials said.

According to the UK Health Security Agency (UKHSA), of the three cases, two are pupils at Budmouth Academy, Weymouth, and the third attends Wey Valley Academy. The authorities have now rolled out meningitis vaccinations to young people in the region.

The latest outbreak comes after a meningitis outbreak was reported in the Kent region in March, which affected more than 30 people, leaving one sixth-form pupil and a university student dead.

Is the Weymouth Meningitis Outbreak Linked to the Kent Outbreak?

As per the UKHSA, the new cases were confirmed between 20 March and 15 April and are not linked to the deadly Kent outbreak.

The two pupils at Budmouth Academy are contacts of each other, but it is reportedly not epidemiologically linked with the Wey Valley Academy case.

The three cases in Weymouth have been confirmed as Meningitis B (MenB) and are the same sub-strain type, but a different sub-strain to the one detected recently in Kent.

Notably, all pupils in years 7 to 13 in Weymouth, Portland, and Chickerell are to be offered antibiotics and the MenB vaccination.

Close contacts of the cases have already been offered antibiotics as a precaution.

Will The Weymouth Meningitis Spread Further?

Also read: Meningitis claimed 259,000 lives globally in 2023: The Lancet

According to UKHSA deputy director Dr Beth Smout, "it is possible that we will see further cases linked to these latest cases in Weymouth".

He stated that the authorities are widening the "offer of antibiotics and vaccination" as "an additional precaution" to reduce the risk of the infection spreading.

"School pupils and staff should attend school as normal if they remain well," the official said.

What Is Meningitis?

Meningitis is a serious medical condition that affects the protective membranes covering the brain and spinal cord, the meninges. While fever is not always present, it is usually considered one of the classic symptoms of meningitis.

It is important to know the varied symptoms, causes, and treatments of meningitis for early diagnosis and proper management of the disease.

Symptoms Of Meningitis

Also read: Unique Symptoms Of Meningitis That Caused An Outbreak In Kent University

Smout urged everyone to be alert to the signs and symptoms of meningococcal meningitis. Common symptoms of meningitis

• Rash
• Headaches
• Neck stiffness
• Fever
• Drowsiness
• Nausea or vomiting
• Increased sensitivity to light.

"If the disease is suspected, you should seek immediate medical attention as the disease can progress rapidly," Smout said.

"The most important short-term thing and the quickest way for people to protect themselves is the antibiotic.

"The vaccine offers longer-term protection. There are two doses, four to six weeks apart, and you are only protected after the second dose," the official said.

A 2026 target trial emulation has found that glucagon-like peptide, also known as GLP-1, which is used by type-2 diabetes patients, can raise the risk of suffering from erectile dysfunction. According to a report published in the European Medical Journal, the impact of GLP-1s on sexual health outcomes in diabetic men has been inconsistent and limited. Erectile dysfunction, however, has been a prominent complication affecting 50 per cent of men with type-2 diabetes over their lifetime.

The effect of GLP-1 on men with type-2 diabetes

For this, researchers analysed the electronic health records of men aged 18 years and above with type-2 diabetes in the US from January 2019 to September 2024. Participants were started on treatment with either dipeptidyl peptidase-4 inhibitors (DPP4i) or GLP-1, with 5,524 and 4,910 individuals, respectively. Men with a history of erectile dysfunction diagnosis or end-stage renal disease were not part of the study population. The mean age of these men was 63 years, and the average BMI was 32.8—55 per cent of participants were White, and 23 per cent were Black. GLP-1 users were younger and had a higher prevalence of obesity compared to DPP4i users.

Higher rate of erectile dysfunction

Experts involved in the study found that the incidence of erectile dysfunction in the GLP-1 group was about 35 cases per 1,000 person-years. In the case of DPP4i users, the number dropped to 28 per 1,000 person-years. Hence, people in the GLP-1 cohort had a 26 per cent higher risk of developing erectile dysfunction over a three-year follow-up period. Results were consistent across subgroups; however, they lacked statistical significance after adjustment for negative outcomes.

Can GLP-1 cause erectile dysfunction?

Researchers noted that the findings of the target trial emulation suggest that sexual health outcomes must be considered in diabetic men, especially those dealing with type-2 diabetes and undergoing treatment with GLP-1 drugs. These findings also highlight the need for randomised trials with standardised erectile dysfunction assessments to further investigate biological pathways.

What complications does type-2 diabetes cause in men?

Type-2 diabetes can cause the following complications in men:

1. Heart disease
2. Stroke
3. Erectile dysfunction
4. Kidney disease
5. Retrograde ejaculation
6. Lower testosterone levels
7. Urinary retention or frequent urination
8. Vision loss—diabetic retinopathy