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.

From weight loss and diabetes to cancers and much more, GLP-1 drugs have delivered blockbuster results and transformed treatment for millions of people worldwide.

Clinical data have consistently shown that GLP-1 receptor agonists containing semaglutide and tirzepatide—including Ozempic, Wegovy and Mounjaro—reduce overall mortality as well as the risk of heart-related deaths.

However, reports from the UK and US have linked these medicines to more than 200 deaths. While a direct causal relationship has not been established and millions of people use these medications safely, high-profile inquests and adverse event databases have highlighted reports of deaths in which these drugs were listed as a suspected contributing factor, including cases associated with severe complications, dosing errors, and the use of counterfeit or compounded products.

UK Reports 82 Deaths Linked to GLP-1 Drugs

Data submitted to the UK's Medicines and Healthcare Products Regulatory Agency (MHRA) show a total of 82 deaths associated with glucagon-like peptide-1 (GLP-1) receptor agonists, the class of drugs used to treat obesity and type 2 diabetes, up to January 31, 2025.

The data includes 22 deaths associated with GLP-1 agonists used for weight loss, while 60 deaths were linked to their use in treating type 2 diabetes. As per the MHRA data:

• 18 deaths were linked to tirzepatide (Mounjaro), including 10 associated with weight loss and eight with type 2 diabetes treatment.
• 29 deaths werelinked to semaglutide products, including Ozempic, Rybelsus and Wegovy. Of these, four were associated with weight loss and 25 with diabetes treatment.
• 35 deaths werelinked to liraglutide products, including Saxenda and Victoza.

"The decision to start, continue, or stop treatments should be made jointly by patients and their doctor, based on full consideration of benefits and risks," said Alison Cave, MHRA Chief Safety Officer.

Northern Ireland Reported Two Deaths in 2026

In 2026, the deaths of two people in Northern Ireland potentially linked to Wegovy and Mounjaro injections were also reported to the MHRA.

The two cases are among more than 500 suspected adverse drug reaction reports submitted from Northern Ireland over the past two years related to GLP-1 medications.

US Reported 162 Deaths

In the US, Ozempic and Wegovy have been linked to 162 deaths since 2018, according to reports in the FDA's FAERS (FDA Adverse Event Reporting System) database.

While none of the deaths have been proven to be directly caused by semaglutide injections, the reports indicate the drugs were listed as a factor in the fatalities.

Growing Use of GLP-1 Drugs

Driven by the rising prevalence of obesity and type 2 diabetes, the use of GLP-1 medications such as Ozempic, Wegovy, Mounjaro and Zepbound has increased dramatically in recent years. The global GLP-1 drug market is estimated to reach $200 billion by 2030.

Although each medication has distinct FDA-approved uses, they share four common mechanisms of action:

• Stimulate insulin release.
• Reduce blood sugar.
• Slow digestion.
• Reduce hunger.

FDA Warning on Unapproved GLP-1 Drugs

In June 2026, the FDA raised concerns about patients and healthcare professionals seeking unapproved versions of GLP-1 receptor agonists, including semaglutide and tirzepatide, for weight loss.

The agency warned that unapproved products do not undergo FDA review for safety, effectiveness or quality before being marketed.

The FDA recommends that:

• Compounded drugs should only be used when a patient's medical needs cannot be met by an FDA-approved drug.
• Patients should obtain a prescription from their doctor and fill it at a state-licensed pharmacy.
• Patients should use the FDA's BeSafeRx campaign resources to safely purchase prescription medicines online.
• Patients should consult their doctor if they have questions about their medications.
• Patients should contact the compounder or telehealth platform where they purchased the drug if they have questions about instructions for use or label information.

What Are The Red Flags

The FDA advises consumers to watch for warning signs, including companies that:

• Claim a compounded drug is the same as an FDA-approved product.
• Offer medicines at deep discounts or prices that seem too good to be true.
• Send medicines that look different from previous prescriptions, arrive in damaged packaging or lack instructions for use.
• Do not require screening and a prescription from a licensed doctor.
• Do not have a licensed doctor available to answer questions after the medication is received.
• Have spelling errors on labels or provide incorrect pharmacy addresses.
• List a pharmacy name on the label that appears to be fraudulent.

The International Agency for Research on Cancer (IARC), the World Health Organization's (WHO) cancer research agency, has classified three widely used medicines—hydrochlorothiazide, voriconazole, and tacrolimus—as Group 1 carcinogens, meaning they are "carcinogenic to humans."

All three medicines are included on the WHO Model List of Essential Medicines and are prescribed to millions of people worldwide for treating hypertension, serious fungal infections, and preventing organ transplant rejection.

A Group 1 classification means there is sufficient scientific evidence that an agent can cause cancer in humans under certain circumstances. However, it does not indicate how likely a person is to develop cancer while taking the medicine as prescribed. The actual risk depends on factors such as the dose, duration of use, individual health, and other risk factors.

Which Medicines Have Been Classified as Carcinogenic?

Hydrochlorothiazide: It is a thiazide diuretic commonly prescribed to treat essential hypertension. Although newer blood pressure medications are increasingly used, it remains a widely prescribed treatment because of the global burden of hypertension.

Voriconazole: It is a broad-spectrum triazole antifungal medicine used to treat invasive aspergillosis and other serious fungal infections, particularly among transplant recipients and other immunocompromised patients.

Tacrolimus: It is an immunosuppressive medicine used to reduce the risk of organ rejection in adult and pediatric transplant recipients and to prevent graft-versus-host disease following stem cell transplantation. Topical tacrolimus is also used as a second-line treatment for atopic dermatitis and vitiligo when topical corticosteroids are unsuitable.

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Why Did IARC Classify Them as Carcinogenic?

"The IARC Monographs Working Group reviewed evidence from epidemiological studies, cancer bioassays in experimental animals, and mechanistic studies to assess the carcinogenic hazard to humans of exposure to these agents and concluded that hydrochlorothiazide, tacrolimus, and voriconazole are all carcinogenic to humans (Group 1)," the IARC said.

• Hydrochlorothiazide has been linked to squamous cell skin cancer and lip cancer because it increases the skin's sensitivity to sunlight.
• Voriconazole is associated with squamous cell carcinoma of the skin through the phototoxic effects of one of its metabolites.
• Tacrolimus has been linked to non-Hodgkin lymphoma and post-transplant lymphoproliferative disorders, largely due to its immune-suppressing effects.

What Does This Mean for Patients?

Dr. Shyam Aggarwal, Chairman, Medical Oncology, Sir Ganga Ram Hospital, told HealthandMe that the classification identifies a cancer hazard, not the level of cancer risk associated with normal therapeutic use.

"The IARC underlines that this Group 1 listing identifies a cancer hazard—the potential of an agent to cause malignancy rather than measuring how great the actual risk is when the medicines are taken at normal therapeutic doses. All three remain listed as essential medicines by WHO, reflecting their critical role in treating serious illness," he said.

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Dr. Aggarwal stressed that patients should not stop taking these medicines without consulting their doctor.

"Abruptly stopping any of these agents can result in dangerous rises in blood pressure, uncontrolled infection, or transplant failure. The recommended course is to speak with the treating physician, adopt rigorous sun-protection habits if taking hydrochlorothiazide or voriconazole, and maintain regular surveillance for those receiving tacrolimus after transplantation," he added.

No Need to Panic

Dr. Tushar Tayal, Associate Director – Internal Medicine, CK Birla Hospital, Gurugram, told HealthandMe the reclassification should not be a cause for alarm.

According to him, the concern relates to long-term cumulative exposure rather than a single dose. Stopping treatment abruptly could pose a much greater immediate risk, including uncontrolled hypertension, severe infection, or transplant rejection.

What Should Patients Do?

• Do not stop or change your medication on your own.
• Consult your treating physician before making any changes to your treatment.
• Discuss whether regular skin examinations or an alternative treatment plan may be appropriate based on your individual risk.
• Use sun protection if you are taking hydrochlorothiazide or voriconazole, as advised by your doctor.
• Attend regular follow-up appointments, especially if you are taking tacrolimus after an organ transplant.

A UK-based surgeon from Egypt has been permanently barred from practising medicine after a medical tribunal found that he made a catastrophic blunder during an emergency bowel surgery.

Dr Yasser Adly Abdel Rahman, who was working as a locum surgeon at Royal Oldham Hospital in Greater Manchester, mistakenly connected the wrong parts of a patient’s digestive system, a procedure experts described as “not known to man.”

Here's What Happened

Dr Rahman carried out the operation on a young man in August 2020. Instead of restoring the patient’s bowel, the surgery created a “closed loop” that caused contents of the bowel to flow back into the stomach.

The error left the patient in unimaginable pain and in a condition deemed “not compatible with life.”

According to findings by the Medical Practitioners Tribunal Service (MPTS), the patient was left feeling severe pain, vomiting and an inability to pass stool after the surgery.

A second surgeon later performed emergency corrective surgery, creating a stoma and saved the patient’s life.

The tribunal heard that Dr Rahman failed to realise the seriousness of the patient’s deteriorating condition and did not adequately respond to concerns raised by the patient’s family and medical colleagues.

An expert from the General Medical Council (GMC) described the erroneous procedure as “as bad as it gets” and said the surgical connection was “not known to man.”

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The Surgeon Was Struck Off From The UK Medical Register

The tribunal ruled that Dr Rahman’s actions amounted to serious professional misconduct.

It also found that, in 2021, after restrictions were placed on his medical practice, he breached them by taking up a locum job in Affidea Express Care Clinic in Ireland in 2022.

Dr Rahman was absent at the misconduct hearing and instead maintained that he was a victim of a witch hint and had been made a “scapegoat.”

But, the tribunal concluded that his incompetence, failure to accept responsibility and repeated breaches of regulatory conditions meant he posed an ongoing risk to patients. He has now been permanently removed from the UK medical register.

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What Is A “Closed Loop” Bowel Obstruction?

A closed loop bowel obstruction occurs when a section of the intestine is blocked at two points, restricting its contents. This can fatally cut off blood supply to the bowel, causing tissue death, perforation, infection and sepsis if not treated urgently.

In this case, the incorrect surgical connections diverted bowel contents back into the patient’s stomach instead of allowing them to pass normally through the digestive tract, creating a life-threatening emergency that required immediate corrective surgery.

While surgical complications can occur even in experienced hands, medical experts told the tribunal this error was far from acceptable.

The case has also drawn attention because the surgeon allegedly ignored warning signs after the operation. He later breached restrictions placed on his medical licence by taking up a job elsewhere. These factors ultimately contributed to the decision to strike him off from the UK register permanently.

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About Dr. Yasser Adly Abdel Rahman

Dr Rahman qualified in 1993 from Ain Shams University in Cairo, Egypt. He trained as a general and colorectal surgeon.

He later worked in the UK as a locum consultant, meaning he was employed on temporary contracts rather than in a permanent consultant position.

At the time of the incident in August 2020, he had only been working at Royal Oldham Hospital in Greater Manchester for a few days before performing the emergency bowel surgery.