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.

South Africa's National Department of Health has announced that it has received a first consignment of 37,920 doses of the groundbreaking, six-monthly HIV prevention injection, Lenacapavir.

Lenacapavir is the first twice-yearly injectable pre-exposure prophylaxis (PrEP) product that can help tackle the burden of HIV worldwide.

South Africa has the world's largest HIV-positive population of approximately 8 million people, with over 6 million currently on antiretroviral treatment.

“The department will, in the next few weeks, announce the official launch of this game changer where the phased implementation plan will be outlined,” said department spokesperson Foster Mohale, in a statement.

"Lenacapavir is preventive medicine, not a vaccine, considered one of the most exciting HIV prevention advances in years," Mohale said.

The Department noted that the medicine is expected to be sustain nearly half a million people in South Africa over the next two years, the statement said, adding that is will be officially rolled out in May.

Notably, the initial phase will target high-incidence districts and vulnerable groups.

What Is Lenacapavir?

Lenacapavir is a critical tool for reaching the Global AIDS Strategy goal of ending AIDS as a public health threat by 2030.

Lenacapavir injection as an additional PrEP option offers a highly effective, long-acting alternative to daily oral pills and other shorter-acting options.

With just two doses per year, lenacapavir is a transformative step forward in protecting people at risk of HIV -- particularly those who face challenges with daily adherence, stigma, or access to health care.

Marketed under the brand name Yeztugo, lenacapavir, developed by global pharma major Gilead Sciences, costs $28,218 per person per year.

However, it is being provided to South Africa through a $29-million USD grant from the Global Fund.

The shot was tested in two major studies involving high-risk groups: one with young women and teenage girls in South Africa and Uganda, and another with gay men and gender-diverse individuals in several countries. In both cases, the results were striking.

The women who received the shot had zero new HIV infections, compared to around 2% in those on daily pills. In the second study, the twice-yearly shot proved just as effective for men and gender non-conforming individuals.

“This really has the possibility of ending HIV transmission,” said Greg Millett of amfAR, The Foundation for AIDS Research.

Lenacapavir: How Does It Work?

Yeztugo is administered as two small injections in the abdomen, forming a medication "depot" that slowly releases the drug into the body over six months.

However, people must test negative for HIV before receiving it, as it doesn’t treat existing infections or prevent other sexually transmitted diseases.

Lenacapavir: Why Access Is A Challenge?

Despite its potential, concerns remain over who will actually benefit from lenacapavir.

In the US, only about 400,000 people currently use any form of PrEP — a small fraction of those who could benefit. And structural issues like cuts to public health funding, limited insurance access, and stigma pose significant barriers.

Globally, the challenge is even greater. While Gilead has struck deals with six generic drug makers, including four Indian, to provide low-cost versions of the shot for 120 low-income countries, critics argue that middle-income nations have been left out.

UNAIDS Executive Director Winnie Byanyima noted that at current prices, the shot “will change nothing” for many who need it.

Rotavirus has been increasingly detected in wastewater in several California cities, sparking concerns about the risk of the deadly and highly contagious virus in young children.

The virus is highly contagious and known for causing fever, vomiting, and severe watery diarrhea among small children. Older children and adults with weakened immune systems also are vulnerable, according to the US Centers for Disease Control and Prevention (CDC).

As per data from WastewaterSCAN, “high concentrations” of rotavirus have been found in Marin, Redwood City, San Jose, and Santa Cruz, while moderate concentrations have been found in Sacramento, Davis, San Francisco, Sunnyvale, Fremont, Vallejo, and Novato, The Sacramento Bee reported.

"It's extremely contagious," Dr. Monica Gandhi, an infectious disease specialist at UC San Francisco, told SFGATE Thursday, explaining that rotavirus is one of the lesser-known gastrointestinal illnesses.

According to UCSF, approximately 50,000 children in the US are hospitalized with it each year.

What Is Rotavirus?

Rotaviruses are the most common cause of severe diarrheal disease in infants and young children worldwide.

The virus, a member of the reovirus family, affects the vast majority of children worldwide before the age of 3 years, and in most developing countries before the first birthday.

The virus causing the infection was discovered in 1973, according to the National Institutes of Health. It causes severe diarrhea, often leading to dehydration, which can be severe, requiring hospitalization.

It is transmitted by

• the fecal-oral route
• directly from person to person,
• indirectly through contaminated objects.

• transient loose stools
• severe diarrhea
• vomiting,
• dehydration,
• electrolyte disturbances,
• shock,
• death if rehydration is not provided.

Is Rotavirus Preventable By Vaccine?

WHO-prequalified rotavirus vaccines have been available since 2008, and there are currently four vaccines available. They are all live, oral vaccines.

RotaTeq, Rotavac, and ROTASIIL should be administered in a 3-dose schedule, while a 2-dose schedule should be used for Rotarix. A minimum interval of 4 weeks should be maintained between doses, the WHO said.

In addition, key measures to prevent diarrhea include the following:

• access to safe drinking water
• use of improved sanitation
• hand washing with soap
• exclusive breastfeeding for the first six months of life
• good personal and food hygiene
• health education about how infections spread.

Resident doctors in the UK have launched a six-day strike in a dispute with the government over pay.

Tens of thousands of medics have walked out of the National Health Service (NHS) in England on Tuesday, in the 15th strike since March 2023. Their demand: “full pay restoration”.

The six-day walkout comes as the doctors’ group rejected an offer made by the government in March.

According to the British Medical Association (BMA), the government’s proposal failed to reverse years of pay erosion and staffing pressures.

The BMA represents about 55,000 of the resident doctors - formerly known as ‌junior doctors - ⁠who make up nearly half of the medical workforce.

The strike is due to run until the morning of April 13, after a 48-hour ultimatum from Prime Minister Keir Starmer passed without agreement.

Doctors Strike: What Is The Reason?

The BMA argues that doctors are still being paid a fifth less than they were in 2008, once inflation is taken into account. This is despite receiving pay rises worth 33 percent over the past four years.

Dr Jack Fletcher, chair of the BMA's resident doctor committee, told BBC Radio 4's Today program he was "genuinely very sorry" to patients who had care postponed due to the strike, but noted that such delays also occurred "without strike action" because of a lack of specialists and GPs.

"The way out of this is to get around the negotiating table, as we were for eight or so weeks, talk constructively to get a deal, to get us out of this.

Dr Emma Runswick, deputy chair of the BMA Council, told BBC Breakfast they had been close to reaching a deal but "the government decided to move the goalposts quite last minute to reduce the level of investment they were prepared to make".

The 15th NHS Doctors' Strike: How Patients Will Be Affected

The strike began at 07:00 BST on Tuesday and promises to cause significant disruption to services.

Dr Melissa Ryan, 45, a pediatric registrar, said she was frustrated that the government was cutting training places and some children were waiting years for assessments, the BBC reported.

The pediatrician who joined dozens of resident doctors in the six-day strike over jobs and pay has said the NHS may "end up without doctors" if the long-running dispute continues.

However, senior medics have being called in to provide cover in emergency settings, still some pre-planned treatments and appointments may get cancelled.

Meanwhile, the NHS has urged patients not to put off seeking help if needed, saying those with emergency and urgent needs should use 999 and 111 as normal, the BBC reported.

While GP services are largely unaffected, the NHS advised patients with prior appointments and treatments scheduled to attend unless told otherwise.

Strikes Costing The NHS £50 Million Daily

Health Secretary Wes Streeting told BBC Breakfast that 95 percent of appointments were still in place. He also apologized to people affected by cancellations, saying they "deserve better".

He criticized the BMA for not accepting the government’s latest offer and said the government had negotiated with the BMA "in good faith".

According to the British government, the strikes were costing the NHS £50m a day, meaning the health service had lost around £3bn since industrial action started in March 2023. However, a detailed breakdown of costs has not been set out.

Speaking on Times Radio on Tuesday, Streeting said resident doctors had secured the largest pay uplift of any public sector group under the Labour government, but had rejected the offer without putting forward a counter proposal.