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.

A popular organic applesauce has been recalled in the US after routine testing by the US Food and Drug Administration (FDA) revealed high levels of patulin, a toxin produced by certain molds that can grow on apples.

Wakefern Food Corp. voluntarily recalled select containers of Wholesome Pantry Organic Unsweetened Apple Sauce after the patulin levels were found to exceed food safety limits. No illnesses linked to the toxin have been reported yet.

The recall involves 23-ounce plastic jars with UPC 04119005677 and a best-by date of June 16, 2027. The product was sold through ShopRite, Price Rite Marketplace, The Fresh Grocer, Gourmet Garage and Fairway Market.

What Is Patulin?

Patulin is a mycotoxin, meaning it is a toxic chemical produced by certain species of fungi or mold.

The FDA identifies molds from genera including Penicillium, Aspergillus and Byssochylamys as sources of patulin. Apples are one of the best-known sources, particularly when fruit is bruised, damaged, rotten or improperly stored.

When contaminated apples are used to make products like apple juice or applesauce, the toxin can remain it. The pasteurisation does not eliminate patulin, so simply heating an apple product is not a reliable way to get rid of the toxin.

Also read: Beer Is Getting A 'Health Makeover': Do Protein Or Electrolytes Really Make It Healthier?

How Dangerous Is Patulin?

The health concern depends on the amount and duration of exposure to patulin. According to the FDA, consuming food or beverages containing high levels of patulin may cause nausea and vomiting, while evidence also indicates that the toxin can damage cells. The agency monitors patulin because prolonged exposure to elevated levels may pose a serious health hazard.

The FDA has established an action level of 50 parts per billion (ppb) for patulin in apple juice, apple juice concentrates and apple juice products.

This does not mean that eating a food once above the regulatory limit automatically causes poisoning. Food safety limits are designed to control exposure and reduce potential health risks, particularly when contamination could occur repeatedly.

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Patulin In Applesauce

Molds formed due to patulin can grow on apples that have been bruised, damaged or allowed to rot. Contamination can also happen during storage.

The problem can be difficult to identify simply by looking at the finished food. FDA guidance notes that some contamination can originate from internal problems like core rot that may not be obvious from the outside of an apple. Removing damaged fruit before processing is therefore an important control measure.

So, anyone who has the recalled Wholesome Pantry Organic Unsweetened Apple Sauce at home should not consume it.

Consumers should check the jar for the 23-ounce size, UPC 04119005677 and best-by date June 16, 2027. The company says recalled products can be returned to the store for a refund or replacement.

Stopping GLP-1 drugs such as Ozempic, Wegovy, Mounjaro and Zepbound may cause some of their cardiovascular benefits to fade, a large new study suggests.

Researchers from Washington University in St. Louis found that people who stopped GLP-1 treatment had a progressively higher risk of major cardiovascular events, including heart attack, stroke and death. After two years off treatment, their risk was 22% higher than among those who continued taking the drugs.

The findings, published in BMJ Medicine, are significant as GLP-1 drugs are widely used to treat type 2 diabetes and obesity and have also been shown to provide cardiovascular benefits.

What Did The Study Find?

Researchers analyzed health data from 333,687 US veterans with type 2 diabetes over up to three years. Of these, 132,551 had been prescribed GLP-1 drugs, while 201,136 had been prescribed sulfonylureas, another class of diabetes medicines.

Treatment status was reassessed every six months. About 26% of GLP-1 users stopped treatment completely, while another 23% had a treatment gap of at least six months before restarting.

The longer people remained off treatment, the greater their cardiovascular risk.

After one year without restarting, the risk of major cardiovascular events was 14% higher than among continuous users. After two years, it was 22% higher.

"There is enormous exuberance about starting GLP-1 drugs, but not nearly enough attention to what happens when people stop," said senior author Ziyad Al-Aly, a clinical epidemiologist at Washington University.

Also read: Are GLP-1 Drugs Safe for Children? Study Finds Nutritional Deficiency in Nearly 17% Within a Year

Continuous Treatment Showed Greater Benefit

People who remained on GLP-1 drugs throughout the three-year study had an 18% lower risk of major cardiovascular events than those taking sulfonylureas.

That translated to about four fewer major cardiovascular events per 100 people over three years.

Those who remained on treatment for two or 2.5 years before stopping also had lower cardiovascular risk, by 7% and 15%, respectively.

However, people who stopped before 18 months did not have a significant reduction in cardiovascular risk compared with those taking sulfonylureas by the end of the study.

Treatment Gaps May Weaken Heart Protection

Interrupting GLP-1 treatment and later restarting it was associated with less cardiovascular protection. While continuous users had an 18% reduction in major cardiovascular events, those who stopped and later restarted had an average 12% reduction.

Even a six-month treatment gap was associated with a 4% to 8% increase in cardiovascular risk compared with continuous use.

Al-Aly said many patients stop GLP-1 drugs because of "cost, side effects or shortages."

"When they stop, it's not just weight that comes back; they experience a resurgence in inflammation, blood pressure, and cholesterol. Weight regain is visible; the metabolic reversal is not," he said.

"Our data suggest this metabolic whiplash is detrimental to heart health," Al-Aly added.

Read More: EXCLUSIVE: GLP-1 Drugs Are The ‘New Statins’, Says University Hospital Birmingham Professor

Can Restarting GLP-1 Drugs Restore The Benefits?

Restarting treatment appeared to restore some cardiovascular protection, but not all of it.

The researchers said the findings suggest that cardiovascular benefits gained during GLP-1 treatment may diminish after treatment is interrupted.

"Clinicians should treat adherence to GLP-1 treatment as an important outcome in its own right -- not an afterthought," Al-Aly said.

He added that healthcare systems should help patients manage side effects, address cost barriers and understand that GLP-1 drugs are used to manage chronic conditions.

The human brain has always been considered to be a single organ. But according to Stanford Medicine researchers, the brain's growth history indicates that it originates from two different populations of early cells that follow separate developmental paths.

The findings, published in Nature Neuroscience, suggest that the front and back parts of the brain develop from different types of progenitor cells, questioning the long-believed idea that the entire brain originates from one common cell.

An important point to note is that this does not mean that humans have two completely separate brains. The two developmental systems ultimately fuse together and function as one brain.

Mechanism Of Brain Forming From Two Cell Groups

During early development, cells called progenitor cells enable the production of specialised brain cells, including neurons. Researchers found that the cells that form the forebrain and midbrain follow a different developmental pathway from those that form the hindbrain, which includes the brainstem.

The forebrain is involved in neurological functions like language, consciousness and higher-level thinking. The hindbrain contains structures that control essential functions including breathing, heartbeat, sleep and swallowing.

Kyle Loh, associate professor of developmental biology at Stanford Medicine and senior author, said, “We’ve shown for the first time that the front of the brain arises from a totally different progenitor cell than the back of the brain.”

He added, “Our discovery means that we can now grow neurons from the back of the brain, the hindbrain, in a petri dish and study their functions.”

Also read: Is Controlling BP Enough After a Brain Bleed? Doctors Explain How to Prevent Another Stroke

A Significant Discovery

Scientists have been able to grow several types of human brain cells in the laboratory, but creating hindbrain neurons has been challenging.

The new findings give some clarity about why some previous approaches were unsuccessful. Researchers were attempting to transform forebrain or midbrain progenitor cells into hindbrain cells, but the Stanford team found that these cells are fundamentally different from the beginning of development.

Jokhai, one of the researchers involved in the study, explained, “Previous attempts to make hindbrain neurons likely tried to coax forebrain and midbrain progenitors into hindbrain cells, which our study shows is not possible.”

He added, “In stem cell biology, people are always fixated with creating the end cell type, like the neuron. But it’s important to begin at the earliest stages of embryonic development.”

Also read: Brain Health After 40: How Diabetes, Menopause And Early Detection Affect Dementia Risk | World Alzheimer’s Day

Study's Implications On Brain Disease Research

The discovery could have various practical implications for neurological research. The hindbrain and brainstem contain neurons involved in breathing, swallowing and movement, meaning researchers need reliable human cells to study diseases that damage these systems.

Stanford scientists say the new findings allowed them to understand and generate functional human hindbrain neurons in the laboratory. This could provide new models for studying conditions like amyotrophic lateral sclerosis (ALS) and spinal muscular atrophy (SMA).

Instead of studying these diseases only in animals or using cells that do not accurately represent the affected brain region, researchers may now be able to grow relevant human neurons and investigate how they develop, malfunction and respond to different treatments.

The finding could therefore change not just how scientists understand the human brain's anatomy, but how they understand its origins and how they recreate different brain regions in the laboratory.