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.

Amid increasing uptake of GLP-1 weight-loss drugs such as Ozempic and Wegovy, FMCG major Nestlé has realigned its nutritional drinks to meet the changing nutritional needs of users.

The company has announced plans to roll out new protein drinks designed for people taking GLP-1 weight-loss medications such as Ozempic and Wegovy in the US, Asia and Australia. Since these drugs curb appetite and can contribute to issues such as muscle loss and “Ozempic face,” Nestlé wants to help users stay healthy while their eating habits change, Reuters reported.

To better understand their nutritional needs, Nestlé is using AI to study clinical research and real-world consumer needs. It is also expanding its high-protein offerings to support muscle health, along with collagen-added products in its Vital Proteins line for skin and hair.

What Are the Protein and Nutrition Needs of GLP-1 Users?

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The number of people using GLP-1 drugs is growing rapidly, with about 16 million Americans currently taking the medications for weight loss. Globally, use remains much smaller than the potential eligible population, with access and affordability still major barriers.

But do GLP-1 users need more protein?

Dr. Navin Gnanasekaran, Longevity Physician, Apollo Hospitals, told HealthandMe that for individuals on GLP-1 receptor agonists, rapid weight loss can lead to a significant reduction in both fat and lean muscle mass. Alarmingly, up to 30-40% of the total weight lost can be muscle.

“Prioritizing protein intake and structured resistance training is absolutely critical to counteract this muscle depletion,” he said.

How Much Protein Do GLP-1 Users Need?

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Dr. Navin said that a daily intake of at least 1.0 to 1.5 grams of high-quality protein per kilogram of body weight is recommended. Lean meats, eggs, dairy and plant-based proteins can help meet these needs.

He also recommended strength training to preserve muscle tissue. Together, adequate protein and resistance training can help support muscle mass and maintain the basal metabolic rate (BMR), which may help prevent weight regain.

Dr. Praveen Gupta, Chairman, Marengo Asia International Institute of Neuro and Spine (MAIINS), Marengo Asia Hospitals, told HealthandMe that a large number of people in India eat vegetarian diets that are already low in B12, iron and vitamin D. These nutritional gaps can quietly widen when food intake is reduced with GLP-1 drugs.

For people following vegetarian diets, familiar kitchen staples such as paneer, dal, soya chunks, hung curd, sprouts and eggs, spread across the day, can help meet protein targets without animal meat.

How Do GLP-1 Drugs Work?

Dr. Praveen said these drugs work by slowing digestion and dialing down “food noise” — the constant mental chatter around eating — which naturally cuts how much a person consumes, sometimes by half.

GLP-1 receptors are located not just in the gut but throughout the central nervous system, including regions such as the hypothalamus and hippocampus that receive direct input from GLP-1-producing neurons in the hindbrain. This is part of why appetite suppression can be so powerful: the drugs act on the brain’s hunger circuitry, in addition to slowing digestion.

Do GLP-1 Drugs Increase the Risk of Nutritional Deficiencies?

The overall appetite suppression caused by these medications can increase the risk of vitamin deficiencies. Constipation is also a common GLP-1 side effect due to decreased dietary fiber intake.

Good hydration, planned nutrient-dense meals and adequate fiber can help offset these effects.

Routine monitoring of essential micronutrients, particularly vitamin D, B12 and iron, is highly advised to ensure patients achieve sustainable, healthy weight loss without compromising their long-term nutritional well-being.

Why Protein Matters

• Reduced food intake: Appetite suppression from GLP-1 drugs can create nutritional gaps, with potential neurological consequences.
• Vitamin B12: Deficiency can cause irreversible nerve damage, including peripheral neuropathy and cognitive impairment.
• Warning signs: Unaddressed deficiencies can cause tingling, numbness, brain fog and unexplained fatigue.
• Muscle loss: A significant share of weight lost on GLP-1 medications can be lean muscle rather than fat if adequate protein intake and physical activity are not prioritised.
• Nutrition matters: Inadequate nutrition can affect both muscle and nerve tissue, making adequate protein and essential micronutrients important during weight loss.

Liver injuries reported to US poison centres increased by nearly 400% between 2000 and 2024, with acetaminophen, sold under brand names such as Tylenol, the most frequently implicated substance, according to a study.

The study analysed poison-centre calls involving liver injuries linked to “xenobiotics”—foreign substances not naturally found in the human body. These include medications, food additives, alcohol and environmental pollutants.

Acetaminophen Among Leading Causes

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Researchers identified 220,160 cases of xenobiotic-related liver injury over the 24 years. Population-adjusted exposure rates increased from 10.9 per million people to 52.9 per million.

More than 80% of the liver injury cases required inpatient care, with medications accounting for the majority of cases. Acetaminophen was the substance most frequently implicated.

“Liver injuries reported to poison centers have increased substantially over the past 25 years, with acetaminophen emerging as a growing contributor,” said Christopher P. Holstege of UVA Health.

Acetaminophen Exposure Trends

The study found that exposures involving acetaminophen-containing combination drugs decreased by 60%-85% after the US Food and Drug Administration capped the amount of acetaminophen allowed in combination prescription products.

However, potentially harmful exposures to acetaminophen alone increased steadily over the 24 years. The findings suggest that regulatory action reduced liver injuries linked to combination products, while acetaminophen alone remained a leading contributor to poison-centre-reported liver injuries.

Females had higher rates of acetaminophen-associated liver injury than males. Suspected suicide was the most common reason for exposure in both sexes.

Alcohol and Other Substances

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Alcohol was the second most common cause of liver injuries, although it was far less common than acetaminophen. Alcohol-related injuries were more frequent in men than women but increased in both sexes during the COVID-19 pandemic.

Researchers also identified increases in liver injuries linked to stimulants and street drugs, herbal and dietary supplements, and environmental toxins. However, these were much less common than injuries associated with acetaminophen and alcohol.

“Medications should always be taken as directed by clinicians and per pharmaceutical label instructions,” Holstege said. He also advised caution with emerging substances that are not regulated.

Why Tylenol Is Linked To Liver Injuries

"Acetaminophen is widely available without a prescription, and it’s contained in many combination medications — more than 600. It’s likely that many people taking acetaminophen do not realize they’re taking too much since, for example, you take acetaminophen tablets for the achy feeling that comes with a cold and also use a combination cough medicine that contains acetaminophen," Howard E. LeWine, Chief Medical Editor, Harvard Health said.

Tylenol and Autism Claims

The debate has also triggered legal action, as Texas sued Kenvue over alleged failures to warn pregnant consumers, and a US appeals court this month revived more than 500 private lawsuits making similar claims.

An immunity-enhancing peptide that has been used in more than 30 countries has gained attention as a possible treatment for Long COVID.

But in the US, the peptide, thymosin alpha-1 remains unapproved. The FDA raising concerns about how the synthetic peptide is developed, formulated and dosed.

Thymosin alpha-1, also known as Tα1 or thymalfasin, is a 28-amino-acid peptide originally derived from the thymus. It is designed to modify the immune response rather than simply suppress inflammation.

Research suggests it can enhance T-cell activity and antibody responses, which has made it particularly interesting in conditions involving immune dysfunction.⁠

Peptide And Long COVID Connection

Research has found that Tα1 may help restore aspects of immune balance in people with post-acute COVID-19.

A 2023 study found that the peptide improved immune homeostasis in blood cells from people with Long COVID. Its effects are particularly evident among patients with more severe initial disease and certain persistent symptoms.

The proposed idea is that rather than simply treating individual symptoms such as fatigue or brain fog, Tα1 could potentially correct some of immune abnormalities underlying them.

The Long COVID findings are still largely based on laboratory and early-stage research. They do not yet establish that injections of Tα1 improve Long COVID symptoms in a large, well-controlled patient population.

Also read: Diabetics Must Undergo Retinal Screening To Protect Eye Health: AIIMS Doctors

So Why Hasn’t The FDA Approved It?

Tα1 has been studied for several conditions, and it is approved in many countries. But FDA approval requires evidence for a specific product, formulation, dose, safety profile and effectiveness.

In the US, thymosin alpha-1 is not FDA-approved for Long COVID or another general medical condition.

The FDA has also raised specific concerns about compounded Tα1. In a 2024 review, the agency evaluated proposed injectable Tα1 products and highlighted concerns including product stability, concentration and the possibility of immune reactions caused by peptide aggregation.

The proposed 3 mg/mL formulation also differed from the 2 mg/mL concentration used in clinical studies reviewed by the agency.

Another crucial distinction is that the biological activity in a peptide does not mean that a particular manufactured product is safe and effective at a specific dose.

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Is The Peptide Truly Capable Of Treating Long COVID?

Some research regarding the peptide’s efficacy on Long COVID is encouraging, but the evidence remains limited. Studies of Tα1 in acute COVID-19 have also produced mixed results.

One clinical study found that it did not alter disease progression or mortality in non-severe COVID-19, although it shortened viral RNA shedding and hospital stay.

Other research has suggested potential benefits in severe disease, but these studies have limitations.

That uncertainty matters even more for Long COVID, where symptoms can vary dramatically between patients and the biological mechanisms remain incompletely understood.

The FDA’s decision does not mean research into Tα1 has been halted. A US clinical trial is currently evaluating thymalfasin as an immune-response enhancer given around COVID-19 vaccination, with the study assessing safety and whether it can improve