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 National Health Service (NHS) has approved teplizumab for people with early-stage type 1 diabetes in England and Wales.

Teplizumab (sold under the brand names Tzield and Teplizumab) is manufactured by French drug maker Sanofi and is the world's first immunotherapy to target the root cause of type 1 diabetes and slow its progression.

It will be made available on the NHS in England and Wales as clinical trial evidence reviewed by the National Institute for Health and Care Excellence (NICE) showed that teplizumab can delay the onset of symptomatic type 1 diabetes by an average of nearly three years.

“This is a genuinely exciting recommendation. For the first time, we have a treatment that can give people diagnosed at an early stage of type 1 diabetes precious extra time before they need to manage the full demands of the condition,” said Helen Knight, director of medicines evaluation at NICE.

Who Is Eligible for Teplizumab?

Teplizumab is used to delay the onset of stage 3 type 1 diabetes in children aged 8 years and older, and adults, with stage 2 type 1 diabetes.

In stage 1 type 1 diabetes, there are no symptoms, and blood sugar levels are normal, but blood tests show the immune system has begun attacking the insulin-producing cells in the pancreas.

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At stage 2, the immune attack has progressed further. There are still no symptoms, but blood tests show early changes in blood sugar levels, indicating a high risk of developing symptomatic diabetes.

Because stage 2 type 1 diabetes has no symptoms, specific tests are needed to diagnose it. There is currently no national screening program. But people are most likely to be identified through:

• Research studies such as ELSA and T1DRA, which screen children and young people aged 2 to 17.

• Testing because of an increased risk, such as having a parent, sibling or child with type 1 diabetes.

• Testing for other medical reasons, including concerns about blood sugar levels.

“Around 1,100 people could be eligible for treatment in the first year, with approximately 555 expected to take it up. From year three, the eligible population is expected to stabilise at around 820 people annually, with approximately 490 expected to receive treatment,” as per NICE.

How Does Teplizumab Work?

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Teplizumab helps regulate the immune system by attaching to a protein called CD3 on the surface of immune cells responsible for attacking insulin-producing cells. This slows damage to the pancreas and delays the onset of the disease.

Evidence for teplizumab comes from the TN-10 clinical trial, which followed 76 children aged 8 years and older and adults with stage 2 type 1 diabetes who had a close family member with the condition. Of the participants, 44 received teplizumab and 32 received a placebo.

Teplizumab delayed the onset of symptomatic type 1 diabetes by approximately 32 months.

How Is Teplizumab Administered?

Teplizumab is given through a drip into a vein once a day for 14 consecutive days. Each infusion takes at least 30 minutes, with the dose gradually increased during the first few days. It is a one-time treatment course.

Patients will need to attend hospital every day during the treatment period, including weekends. The NICE committee noted that daily travel may be difficult for some people because of cost or practical considerations.

Sanofi has agreed a commercial arrangement with NHS England, meaning teplizumab will be available to the NHS at a confidential discounted price.

The Ebola outbreak in the Democratic Republic of Congo (DRC) is worsening, with confirmed cases rising to 1,048 and the death toll reaching 267, according to government data.

The country has also reported 112 recoveries, while contact tracing coverage has improved to 70.8%. However, significant gaps remain. The World Health Organization (WHO) estimates that at least 95% of contacts must be traced to effectively contain an outbreak.

The outbreak caused by the Bundibugyo strain, with no vaccine or anti-viral, is spreading rapidly, even as response measures are being intensified.

"The outbreak remains serious and is evolving very fast. However, I have seen a response that is growing stronger every day," said Marie-Roseline Belizaire, WHO Regional Emergencies Director for Africa, speaking to reporters in Bunia, the epicenter of the outbreak.

Suspected Cases In Israel Test Negative

Meanwhile, Israel's Health Ministry said test results for two men hospitalized on suspicion of Ebola infection were negative.

The ministry stressed that no confirmed Ebola case has been diagnosed in Israel and advised the public to avoid non-essential travel to areas experiencing active outbreaks.

In addition, it urged travelers returning from Ebola-affected regions who develop fever or unusual symptoms within 21 days of their return to stay home and avoid contact with others.

Nearly 3 Million Children at Risk

UNICEF has warned that nearly 3 million children and adolescents face growing risks in eastern DRC.

According to the UN agency, an estimated 2.95 million children and adolescents aged 18 and under — representing 54% of the population across 31 affected health zones — are at risk from both Ebola and the disruption of essential services.

In Ituri province alone, Ebola has left more than 130 children orphaned, creating an urgent need for protection and care.

“Our teams in Ituri have met children who have lost their mothers, and in some cases both parents, to Ebola," said UNICEF Executive Director Catherine Russell. "Children are trying to make sense of the threat while surrounded by rumors and online misinformation.”

Although the situation remains fluid, children and adolescents account for approximately 15% of confirmed Ebola cases and more than 25% of confirmed deaths in eastern DRC as of June 19.

Children and adolescents with confirmed Ebola are almost twice as likely to die as adults, highlighting the disproportionate impact of the outbreak on younger populations.

Children Affected In Uganda

In Uganda, 20 Ebola cases and two deaths have been confirmed among individuals who travelled from the DRC seeking testing and treatment.

Children have also been affected. One child has tested positive for Ebola, while 19 others are under quarantine monitoring, the UNICEF said.

“Children are especially vulnerable because they depend on caregivers and cannot distance themselves from a sick parent or sibling in the same way that an adult can. To better protect children, we need sustained access, and the resources needed to reach every affected community," Russell added.

Marketa Vondrousova, the 2023 Wimbledon singles champion, has been banned from professional sport for four years after refusing an anti-doping test.

According to an independent tribunal, the 26-year-old provided “no compelling justification” for declining to provide a sample after being notified at her home by a doping control officer in December.

“We recognize that this is a significant ban. And the reason for that is that you can’t have an anti-doping system where a player is in a better place by refusing to take a test than they would be by taking the test and testing positive,” said Karen Moorhouse, chief executive of the International Tennis Integrity Agency (ITIA).

“That feeds into the structure of the doping rules that provides for a starting point of a four-year ban for refusing to take a test, the same as a starting point for testing positive,” she added.

The Czech player said in April that she feared for her safety when the officer called and claimed the officer had failed to follow protocol.

Vondrousova reached the French Open final in 2019, won an Olympic silver medal in 2021, and achieved a career-high ranking of No. 6.

“I have never doped, I have never had a positive test. Throughout my entire career, I have undergone countless anti-doping controls and have always stepped onto the court with a clear conscience. I cannot say what comes next. For the first time in my life, I do not have a plan,” she said in a statement.

She is suspended from all professional events until June 21, 2030, but has the right to appeal the decision to the Court of Arbitration for Sport (CAS).

According to Vondrousova, the doping control officer did not adhere to the rules by approaching her outside the hour she had designated under the whereabouts rules. During the hearing, Vondrousova said stress and poor mental health had affected her decision-making, in addition to her safety concerns.

How Doping Tests Work

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Doping control (testing) is one tool that Anti-Doping Organizations (ADOs) use to level the playing field and protect clean sport.

As per the World Anti-Doping Agency (WADA), athletes playing at the national or international level can be subject to doping control and can be tested anytime or anywhere.

Here's how the process works as per WADA:

• Notification: A doping control officer (DCO) informs the athlete that they have been selected for testing.
• Reporting: The athlete must report to the doping control station, with limited exceptions such as medal ceremonies.
• Sample Selection: The athlete chooses a urine collection vessel or a blood collection kit.
• Sample Collection: Urine collection is witnessed by a DCO or chaperone. Blood samples are collected by a blood collection officer.
• A and B Samples: The sample is divided into A and B bottles. The B sample can be tested if the A sample returns a positive result.
• Sealing: The athlete seals the sample bottles.
• Quality Check: Urine samples are checked to ensure they meet laboratory standards. Additional samples may be required if they are too dilute.
• Documentation: The athlete completes a Doping Control Form (DCF), recording relevant information and receiving a copy.
• Laboratory Testing: The sealed sample is sent to a WADA-accredited laboratory for analysis, with the athlete's identity kept anonymous.