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 US Department of Health and Human Services (HHS) has terminated 16 grants worth a combined $38 million, including programmes focused on maternal and infant health, postpartum care and infant mortality, as the agency shifts funding priorities towards infertility and physical activity.

The grants, administered through HHS’ Office of Minority Health (OMH), were cancelled on August 25, according to reports. The affected programmes had already received funding for the first two years of their four-year grants.

The move has sparked criticism, particularly because some of the cancelled programmes were directly focused on supporting mothers and babies after childbirth.

HHS Shifts Focus To Infertility And Male Reproductive Health

According to the letters sent to grantees, future awards should directly support efforts aimed at “reducing overmedicalization in health care by addressing the root causes of infertility.”

The areas listed by HHS include hormonal imbalances, endometriosis, uterine fibroids, low sperm count, low testosterone levels and erectile dysfunction (ED). Programmes promoting “regular physical activity and exercise” were also listed among the priorities.

For grants dealing with maternal health, officials reportedly acknowledged that maternal and infant health remained important but said the specific projects did not advance minority health within OMH’s current priority are.

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Which Health Programmes Lost Funding?

Among the affected programmes was an initiative by Illuminate Colorado, which sends nurses to the homes of minority women following childbirth to check on the health of mothers and newborns.

“It was news to us that maternal and infant fatality prevention wasn’t a priority,” Jillian Fabricius, co-executive director of the organisation, told NOTUS.

Another programme administered by Housing Works and EngageWell helped people with hypertension monitor their blood pressure at home and provided fresh produce and eggs to 150 New Yorkers every two weeks.

The cancelled grants also included programmes focused on cancer screenings, suicide prevention among first responders and reducing obesity among Native American youth.

At the University of Arkansas for Medical Sciences, a programme aimed at reducing maternal and infant mortality among Black families in the Arkansas Delta could also end because of the funding loss.

Leslie Taylor, a university spokesperson, said the issue was “certainly a big issue in our state” given Arkansas’ high maternal and infant mortality rates.

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HHS Decision Is Drawing Criticism

The cancellations come amid a bigger shift in US federal health policy under the Trump administration, with HHS increasingly emphasising infertility, chronic disease prevention, exercise and what officials describe as addressing the underlying causes of health problems.

However, critics argue that programmes addressing maternal and infant mortality are also essential preventive healthcare, particularly for minority communities that experience significant health disparities.

“It is shocking that OMH under any leadership would prioritize erectile dysfunction over the health and wellbeing of infants and new mothers,” Representative Diana DeGette, the ranking Democrat on the House Energy and Commerce health subcommittee, wrote to HHS officials.

Atherosclerosis, in which plaque builds up inside the arteries, is a major cause of cardiovascular disease and can lead to heart attacks, strokes and sudden death. A new study published in The New England Journal of Medicine found that plaque buildup can begin decades before symptoms appear.

An international team of researchers found atherosclerosis in many apparently healthy young adults, including those in their 20s.

Dr Borja Ibáñez, Scientific Director of the Centro Nacional de Investigaciones Cardiovasculares Carlos III (CNIC), said the findings point to a new approach to cardiovascular prevention: detecting atherosclerosis through imaging before symptoms appear, rather than relying only on risk factors such as blood pressure, cholesterol and smoking.

Plaque Can Appear In The 20s

The study included 16,808 people aged 18 to 70 from Denmark and Spain. None had a known history of atherosclerotic cardiovascular disease.

Using advanced imaging, researchers examined the carotid, femoral and coronary arteries for plaque. Overall, 57.1% of participants had atherosclerotic plaques, despite having no symptoms or previous diagnosis of cardiovascular disease.

Atherosclerosis was detectable even among the youngest participants. Among those aged 18 to 29, plaque was found in:

• 8.7% of men
• 6.7% of women

The prevalence increased with age, reaching nearly 90% among people aged 60 to 70. By 60–70, only about 1.9% of men and 8.1% of women had no detectable plaque in any of the arteries examined.

Men Develop Plaque Earlier

The study found differences between men and women. Atherosclerosis began increasing at younger ages in men, with their atherosclerotic profile appearing five to 10 years earlier than in women.

In women, the sharpest increase occurred between 40 and 60, broadly coinciding with the menopausal transition.

Could Ultrasound Detect Silent Atherosclerosis?

Conventional cardiovascular risk scores, including SCORE2, identified only a small proportion of people who already had silent atherosclerosis.

Researchers found that people with coronary artery plaque often also had plaque in the carotid or femoral arteries. Because these arteries can be examined using relatively simple, non-invasive ultrasound, the finding could have implications for future screening.

Dr. Ibáñez said portable ultrasound devices could potentially become a tool for detecting atherosclerosis from early adulthood.

“The future of cardiovascular prevention must be more precise and personalized,” he said, adding that early detection could allow earlier intervention and more targeted treatment.

Plaque Does Not Mean A Heart Attack Is Imminent

Dr. Sudhir Kumar, neurologist at Apollo Hospitals, Hyderabad, said atherosclerosis can remain silent for decades before causing a heart attack, ischemic stroke or peripheral arterial disease.

However, having plaque does not mean a heart attack or stroke is imminent. Greater plaque burden and more widespread disease are associated with higher cardiovascular risk.

He also stressed that atherosclerosis is not simply an unavoidable consequence of ageing. Its progression can be slowed by addressing modifiable risk factors.

How To Lower Cardiovascular Risk

• Regular aerobic and strength exercise
• Avoiding tobacco
• Eating a healthy diet and limiting ultra-processed foods
• Controlling blood pressure
• Managing LDL cholesterol/ApoB when indicated
• Preventing and treating diabetes
• Maintaining a healthy waist
• Getting adequate sleep.

15-year-old Tanvi Pariyani’s death at AIIMS Delhi has raised questions about the treatment of a rare and complex congenital heart condition she had been living with since childhood.

Tanvi, from Kota, had been visiting AIIMS since she was two. Her medical records listed ventricular septal defect (VSD) with pulmonary atresia, a combination that can make treatment considerably more complicated than just a 'hole in the heart'.

Tanvi’s family has alleged that corrective surgery was repeatedly postponed. AIIMS, however, said its treating team concluded in 2017 that corrective surgery was not feasible because of the complexity of her cardiac anatomy and advised medical management.

The hospital has now constituted a committee to review her complete clinical records, investigations, treatment, expert opinions and the circumstances surrounding her death. An autopsy is also underway.

What Is Pulmonary Atresia With VSD?

A VSD is a hole in the wall separating the heart’s two lower chambers. The right side of the heart pumps oxygen-poor blood towards the lungs through the pulmonary artery.

In pulmonary atresia, the normal route through which blood leaves the right side of the heart and reaches the lungs is blocked or has not developed properly.

This can severely block blood flow to the lungs and reduce the amount of oxygen entering the bloodstream.

When pulmonary atresia occurs along with VSD, doctors have to deal with multiple abnormalities rather than simply closing the hole.

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Treatment Is Complicated

Some children may initially require procedures to ensure adequate blood reaches the lungs. Doctors may use medicines temporarily and later create an alternative pathway for blood flow through a shunt.

In some patients, the pulmonary arteries remain very small and the body develops additional blood vessels supplying the lungs.

These vessels, called major aortopulmonary collateral arteries (MAPCAs), may need to be brought together through a procedure called unifocalisation.

A conduit may then be used to connect the heart to the lungs, while the VSD may also need to be closed.

The anatomy can also change as a child grows. Small pulmonary arteries, abnormal blood vessels and rising pressure in the lungs can make later surgical repair more challenging.

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Events Leading Upto The Teen's Unfortunate Death

According to AIIMS, Tanvi was admitted on August 24 after her condition deteriorated and was being evaluated for a possible heart-lung transplant.

On September 1, she developed severe cyanosis, and her oxygen saturation fell to around 48%. AIIMS said she subsequently suffered a hypoxic spell followed by cardiac arrest. Despite oxygen support and resuscitation, she could not be revived and was declared dead at 5:06 am.

“The Director, AIIMS, New Delhi has constituted a committee to examine the matter in detail, review the sequence of events and establish the facts,” the institute said.

The committee’s findings and autopsy report will be important in establishing what happened and whether any intervention could have altered the outcome.