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.

Environmental and public health scientists have begun warning against the dangers of having free living amoeba in water systems that are capable of triggering severe diseases in humans.

In a recent perspective article published in Biocontaminant, the researchers noted that climate change, deteriorating water infrastructure and limited systems for monitoring and detection are the key factors that have allowed these pathogens to spread and persist.

Corresponding author Longfei Shu of Sun Yat sen University explained: "What makes these organisms particularly dangerous is their ability to survive conditions that kill many other microbes.

"They can tolerate high temperatures, strong disinfectants like chlorine and even live inside water distribution systems that people assume are safe."

The scientists also emphasized that not only can amoebae spread illnesses on its own, it can also act as hidden carriers for other harmful microbes.

By sheltering bacteria and viruses inside their cells, amoeba these unicelled organisms protect these pathogens from disinfection and help them persist and spread in drinking water systems. This so-called Trojan horse effect may also contribute to the spread of antibiotic resistance among humans.

How Dangerous Is Amoeba?

Amoeba are single-celled organisms that naturally live in soil and water. Most species do not cause harm yet some can prove to be fatal.

Some of the diseases caused by this kind of bacteria include Amebiasis (Amoebic Dysentery), an intestinal infection by Entamoeba histolytica, causing diarrhea, cramps and potential liver abscesses as well as Primary Amoebic Meningoencephalitis (PAM) from Naegleria fowleri, a rare but nearly always fatal brain infection from contaminated water entering the nose.

Effects of amoeba-caused infections range from intestinal issues (liver abscesses, anemia, peritonitis) to severe neurological damage (coma, seizures, death) from brain-eating types, with Acanthamoeba causing eye infections (keratitis).

Experts recommend thoroughly washing your hands after toilet use and before handling food, drinking clean water especially in unsanitary conditions and avoiding getting water up your nose in warm freshwater to prevent such infections.

The Indore Crisis

This comes days after the recent Indore sewage water controversy which has claimed the lives 10 people and left over 1,400 people hospitalized, according to Indore Mayor Pushyamitra Bhargava.

However, locals claim that the outbreak has instead caused the death of 17 residents, including a six-month-child. The situation has also left Parvati Bai, 67, with kidney failure, a brain stroke and symptoms of Guillain-Barré Syndrome, or GBS.

GBS is a rare condition where your immune system attacks the nervous system and can cause paralysis as well as death, in certain cases.

The outbreak occurred due to lapses in civic infrastructure. Investigation revealed that a toilet constructed directly above a main drinking pipeline near a police outpost, without a mandatory safety tank resulted in the sewage mixing with drinking water.

The US Food and Drug Administration has approved the use of a blood test which can help diagnose Alzheimer’s disease in adults aged 55 and above.

The blood test, known as Lumipulse, can detect amyloid plaques associated with Alzheimer’s disease and has proven to be a “less invasive option” that “reduces reliance on PET scans and increases diagnosis accessibility.”

FDA Commissioner Martin A. Makary said of the landmark decision, "Alzheimer’s disease impacts too many people, more than breast cancer and prostate cancer combined.

"Knowing that 10% of people aged 65 and older have Alzheimer's, and that by 2050 that number is expected to double, I am hopeful that new medical products such as this one will help patients."

It remains unclear when this test will be available for commercial use across the world.

What Is Alzheimer’s Disease?

About 8.8 million Indians aged 60 and above are estimated to being living with Alzheimer's disease. Over seven million people in the US 65 and older live with the condition and over 100,00 die from it annually.

Alzheimer's disease is believed to be caused by the development of toxic amyloid and beta proteins in the brain, which can accumulate in the brain and damage cells responsible for memory.

Amyloid protein molecules stick together in brain cells, forming clumps called plaques. At the same time, tau proteins twist together in fiber-like strands called tangles. The plaques and tangles block the brain's neurons from sending electrical and chemical signals back and forth.

Over time, this disruption causes permanent damage in the brain that leads to Alzheimer's disease and dementia, causing patients to lose their ability to speak, care for themselves or even respond to the world around them.

While there is no clear cause of Alzheimer's disease, experts believe it can develop due to genetic mutations and lifestyle choices, such as physical inactivity, unhealthy diet and social isolation.

Early symptoms of Alzheimer's disease include forgetting recent events or conversations. Over time, Alzheimer's disease leads to serious memory loss and affects a person's ability to do everyday tasks.

There is no cure to this progressive brain disorder and in advanced stages, loss of brain function can cause dehydration, poor nutrition or infection. These complications can result in death.

How Does The Test Work?

As explained by Dr Abhay Moghekar, an associate professor of neurology at Johns Hopkins University School of Medicine, who helped study and evaluate the test for FDA approval, "If this test is positive, there’s a greater than 90% chance that you have amyloid plaque in your brain.

"Getting a blood test is gonna be far easier, quicker and cheaper,” he said. “It’s going to allow early access to therapy, so it is going to revolutionize care of patients with dementia."

However, the federal agency also noted certain limitations associated with the test such as it can only be used for patients 55 and older who are already experiencing memory problems.

The FDA also cautions that the test is not intended as a standalone diagnostic tool for Alzheimer’s and results should be interpreted based on the patient’s medical history and other assessments, such as cognitive testing.

People who stop using weight-loss medications can regain weight and return their original size within two years, a new BMJ study says.

Researchers have found that those who lose weight using blockbuster GLP-1 drugs such as Ozempic could regain about 0.4kg every month after quitting these treatments. In contrast, those who lost weight through exercise, diet and other factors only gained 0.1kg.

Investigator Dr Susan Jebb, from Oxford University told the BBC, "People buying these need to be aware of the risk of fast weight regain when the treatment ends."

Ozempic (semaglutide) is a prescription injectable GLP-1 medication primarily approved for adults with Type 2 diabetes to manage blood sugar levels. However, the drug has gained immense popularity among those trying to lose weight as it can reduce hunger and help people feel full for longer, which forces the body to burn fat deposits to stay functional.

In clinical trials, people with obesity using semaglutide have shown to lose an average of about 15% of their body weight over 68 weeks. Most people begin to see noticeable results within 8 to 12 weeks of taking the drug.

The official price in India for a once-weekly Ozempic injection pen ranges from approximately ₹8,800 for the 0.25 mg dose to around ₹11,175 for the 1 mg dose per month. Insurance coverage is generally inconsistent for weight loss indications.

What Did The Study Find?

The researchers analyzed 37 studies that included 9,341 participants out of which nearly half had taken had taken GLP-1 medications. This included 1,776 people who received the newer, more effective drugs semaglutide, sold as Ozempic and ‌Wegovy by Novo Nordisk , and tirzepatide, sold ‌as Mounjaro and Zepbound by Eli Lilly.

Apart from discovering that patients could regain all their weight in 1.7 years, the scientists also found that those who lost weight using semaglutide ‍and tirzepatide, cwould gain 0.8 kg per month.

Dimitrios Koutoukidis, Oxford University researcher and senior study author, “But because people on semaglutide or tirzepatide lose more weight ‍in the first place, they all end up returning to baseline at approximately the same time".

Heart health risk factors, such as blood pressure and cholesterol levels, that benefited ⁠from the drugs were projected to return to pre-treatment levels within 1.4 years after stopping the medications.

Why Does The Weight Come Back?

Dr Adam Collins, an expert in nutrition at the University of Surrey, told the BBC that when the body stops receiving a regular dose of appetite suppressants such as GLP-1 drugs, hunger returns and can lead to overeating.

He told the publication, "Artificially providing GLP-1 levels several times higher than normal over a long period may cause you to produce less of your own natural GLP-1, and may also make you less sensitive to its effects.

"That's not a problem when taking the drugs, but as soon as you withdraw this GLP-1 'fix', appetite is no longer kept in check and overeating is far more likely.

"This is further exacerbated if the individual in question has relied solely on GLP-1 to do the heavy lifting... artificially suppressing their appetite without them establishing any dietary or behavioural changes that would help them in the long run."