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.

Fatty liver, or non-alcoholic fatty liver disease (NAFLD), refers to the accumulation of excess fat in liver cells in people who consume little or no alcohol. In its early stages, it may seem harmless. However, it is, in fact, the liver’s first warning that the body’s metabolic balance is burdened. What is concerning is who we are now diagnosing. Young adults in their 20s and early 30s, often with no visible signs of illness, are clear evidence of this condition. This is no longer an additional finding but has become routine. Dr Kandarp Saxena, Gastroenterologist, Manipal Hospital, Jaipur, recently spoke about how fatty liver, which is now becoming more common among younger people, may soon become a lifestyle crisis.

A Lifestyle That Directly Impacts the Liver

Irregular eating habits, such as late-night meals or long gaps followed by overeating, can further throw off the body’s natural metabolic balance. Poor sleep adds another layer, affecting insulin sensitivity and fat metabolism. These are not abstract risks but measurable contributors to how and why fatty liver is developing.

Why Most Young Patients Do Not Realise It

Unlike many other conditions, fatty liver does not produce symptoms that prompt early medical attention. In the early stages, the liver continues to function normally, so daily life goes on as usual. There are no obvious signs to suggest that anything is changing beneath the surface.

Most diagnoses in this age group are incidental, detected during routine blood tests showing mildly elevated liver enzymes or through ultrasound imaging done for unrelated reasons. The absence of these symptoms is not a favourable feature. It delays recognition at a stage when the condition is most easily reversible.

The Indian Risk Profile Is Different

The early onset of fatty liver in India cannot be viewed in the same way as in Western populations. South Asians are known to develop metabolic complications at lower body mass indices. This means that even people who appear healthy or not overweight may still carry harmful fat deep inside the body, along with underlying insulin resistance.

When this is combined with rapid urbanisation, less movement in daily life, and a growing dependence on calorie-dense foods, it slowly adds up to a higher overall risk. As a result, fatty liver is appearing earlier and progressing faster in this population.

From Fat Accumulation to Liver Damage

It is important to understand that fatty liver is not a static condition. In some individuals, simple fat accumulation remains stable. In others, it moves beyond fat build-up and starts irritating the liver, leading to a stage called non-alcoholic steatohepatitis (NASH). This is important because the liver is no longer just holding fat; it is getting damaged.

As the damage continues, the liver tries to heal, but this repair leaves behind scar tissue, known as fibrosis. Over time, this scarring can build up and start to affect how well the liver works. If it continues, it can lead to cirrhosis, where the liver becomes heavily scarred and begins to struggle, increasing the risk of liver failure and cancer. This progression does not happen abruptly; it occurs over years, often without clear clinical warning, making early identification critical.

Why Early Intervention Is Being Missed

Despite being detectable and reversible in its early stages, fatty liver is often not addressed with the urgency it requires. Mild elevations in liver enzymes are sometimes overlooked. Imaging findings are not always followed up with structured intervention. More importantly, younger patients are less likely to be counselled about long-term risk. There is also a tendency to delay action because the condition does not immediately affect quality of life. This delay allows progression that could otherwise have been prevented.

Treatment Exists—but Depends on Behaviour

There is no single drug that reverses fatty liver in the way lifestyle modification does. Clinical evidence consistently shows that sustained weight reduction, regular physical activity, and dietary changes can significantly reduce liver fat and, in some cases, reverse early damage. However, these interventions require consistency. Short-term efforts do not produce lasting benefit. Without sustained change, the underlying process continues.

A Shift That Needs Recognition

The increasing prevalence of fatty liver in young Indians is not an isolated clinical observation; it reflects a shift in how disease is presented. When a condition that was once seen later in life starts appearing a decade or two earlier, it changes the health trajectory of an entire population. It raises the chances of long-term complications and means people end up living with the disease for much longer. Fatty liver is now emerging as one of the earliest indicators of this shift.

Fatty liver does not begin with symptoms. It begins with accumulation of excess calories, reduced activity, and sustained metabolic imbalance. By the time it is detected, the process is already in motion. The challenge, therefore, is not just in treating the condition but in recognising it early enough to change its course.

Only months ago, India was declared the 'Diabetes Capital of the World'. And now, according to a recent study, 20 per cent of Indians have also been found to be prediabetic. While the factors responsible can be both diet and genetic-related, doctors say that Indians develop insulin resistance at a relatively younger age, and despite low body weight contrary to the rest of the world. Diabetes, specifically type-2 diabetes, is a lifestyle disorder triggered by poor eating habits and a sedentary lifestyle. Genetics, too, has a role to play in it. However, when it comes to prediabetes, there is a lot that one can do to bring high blood sugar under control.

What is prediabetes?

Prediabetes is a state characterised by high blood sugar levels, and it is the final stage before developing type-2 diabetes. At first, prediabetes does not show many symptoms, but it can, over time, silently become diabetes; therefore, regular check-ups and following a balanced diet are crucial. Prediabetes is usually triggered by obesity, inactivity, and insulin resistance. For diagnosis, fasting plasma glucose and A1C tests are done, and if prediabetic, weight loss, healthy diet are key to prevention.

What are the symptoms of prediabetes?

If your blood sugar count slips towards the risky side of the scale, there may not be prominent symptoms at the start. However, some subtle early symptoms are noteworthy, such as:

1. Blurred vision
2. Dark skin in the armpits or near the neck
3. Intense thirst
4. Excessive hunger
5. Fatigue
6. Frequent urination at night
7. Slow-healing cuts and infections

Why is screening delayed?

In most cases, prediabetes develops without any noticeable early symptoms. Over time, with sedentary lifestyle habits and excessive intake of ultraprocessed foods and refined carbs, belly fat, poor sleep, and stress, younger people also become prediabetic. And because the symptoms do not always stand out as something abnormal. As a result, many do not go for check-ups. But for diabetes prevention or even for its management, it is important to get tests like fasting blood glucose or HbA1c, as they will help you seek treatment depending on the severity of the condition. At present, people with risk factors such as PCOS, excessive weight, sedentary lifestyle, or hypertension, can become prediabetic even in their mid or late 20s.

Diabetes prevalence in India

The stats for diabetes in India are concerning - over 100 million people are living with diabetes, and 130-140 million are likely prediabetic. However, being prediabetic does not mean that it will for sure progress to diabetes. Without proper intervention, 5-10 per cent of prediabetic patients develop diabetes every year.

Reversing diabetes with lifestyle changes

Treating prediabetes is not complicated - all you need to do is make some dietary changes and work out regularly to lose some weight and bring blood sugar under control. Even 150 minutes of moderate-intensity workout can go a long way to improve insulin sensitivity. Even losing 5-7 per cent of your existing body weight can significantly reduce diabetes risk.

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".