Features of immune system ageing can be detected in the earliest stages of rheumatoid arthritis (RA), even before clinical diagnosis, a new study has found which provides at-risk individuals with hope for early intervention.
The research led by academics at the University of Birmingham, delivered through the National Institute for Health and Care Research (NIHR) Birmingham Biomedical Research Centre, and published in the journal eBioMedicineshows that individuals with joint pain or undifferentiated arthritis already exhibit signs of a prematurely aged immune system, suggesting that immune ageing may play a direct role in the development of RA.
The study involved 224 participants across various stages of RA development and was funded by FOREUM and the European League Against Rheumatism (EULAR). It represents one of the most comprehensive analyses of immune ageing in RA to date.
Researchers found that patients with early immune ageing features were more likely to develop RA. These findings could lead to the development of predictive tools that identify at-risk individuals and enable timely treatment.
“We’ve discovered that immune ageing isn’t just a consequence of rheumatoid arthritis—it may be a driver of the disease itself,” said Dr Niharika Duggal, senior author of the study and Associate Professor in Immune Ageing at the University of Birmingham. “We found that people in the early stages of rheumatoid arthritis ie, before a clinical diagnosis show signs of faster immune system ageing.
“These findings suggest we might be able to intercept the disease development in at-risk individuals and prevent it from developing by using treatments that slow ageing, such as boosting the body’s natural process for clearing out damaged cells (autophagy).”
Key Findings
Hallmarks of immune ageing, including reduced naïve T cells and thymic output, were observed in patients with early joint symptoms.
An elevated IMM-AGE score revealed accelerated immune ageing in patients before RA diagnosis.
Elevated levels of inflammatory markers (such as IL-6, TNFα, and CRP) were found in preclinical stages.
Advanced ageing features, including senescent T cells and inflammatory Th17 cells, appeared only after RA was fully established.
The study suggests that targeting ageing pathways could offer new strategies to prevent RA. Future research should determine whether geroprotective drugs such as spermidine (autophagy booster), senolytics (clearance of senescent cells) and metformin (attenuates inflammation and boosts autophagy) may help slow or halt disease progression in high-risk individuals.
Genomic and hormone study of white Europeans finds 22 additional disease-related variants
Ball and stick 3D model of testosterone. Source: Wikimedia CC0
Researchers identified almost two dozen previously unknown genetic variants linked to type 2 diabetes by including participants’ hormone levels in their analysis. Yan V. Sun of Emory University, USA, and colleagues reports these findings in the open-access journal PLOS Genetics.
Type 2 diabetes affects an increasing number of people worldwide, and more often affects men than women. The disease is caused by a mix of genetic and lifestyle factors, but little is known about how someone’s environment – both inside and outside the body – interacts with their genes to impact a person’s risk of developing the disease.
In the new study, researchers performed genome-wide interaction studies to investigate whether a person’s hormone levels interact with their genetic variants to affect their risk of developing type 2 diabetes. They grouped males and females independently and considered measurements of three types of sex hormones – total testosterone, bioavailable testosterone and sex-hormone binding globulin. The information came from white European participants in the UK Biobank, which contains biological samples and health data from half a million people.
The researchers used statistical analyses to identify relevant variants in the genomes of individuals with and without type 2 diabetes. By taking into account hormone levels, the analysis was able to identify 22 spots on the genome that increased a person’s risk for type 2 diabetes. These variants had not been reported previously in the most recent genomic study for type 2 diabetes.
The new study suggests that a person’s hormone levels may be interacting with their genes to increase their odds of having type 2 diabetes. For future studies, the researchers recommended that additional hormone measurements for each participant and more diverse cohorts should be included. They conclude that this approach, which includes environmental factors in genomic studies, may help us to identify additional disease-related genes and gain a better understanding of the mechanisms behind complex diseases.
The authors add, “We found that sex hormone levels contribute to differences in genetic risk factors for type 2 diabetes in men and women. By analyzing data for men and women separately, we identified new genetic associations with type 2 diabetes.”
The lead analyst, Amonae Dabbs-Brown notes, “I actually used to work at the CDC developing methods to measure some of these sex hormones. It’s really exciting to see what happens downstream. Maybe one day I’ll even get to see how these analyses are used in the clinic!”
Provided by PLOS
In your coverage, please use this URL to provide access to the freely available paper in PLOS Genetics: https://plos.io/3ViXDKH
Citation: Dabbs-Brown A, Liu C, Hui Q, Wilson PW, Zhou JJ, Gwinn M, et al. (2025) Identification of gene-sex hormone interactions associated with type 2 diabetes among men and women. PLoS Genet 21(9): e1011470. https://doi.org/10.1371/journal.pgen.1011470
Author countries: United States
Funding: This work is supported in part by funding from the National Institutes of Health (HL154996 to YVS, DK139632 to YVS, and HL156991 to YVS). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. YVS received salary support from the National Institutes of Health.
Competing interests: The authors have declared that no competing interests exist.
Epidemiological studies have revealed a strong correlation between red meat consumption and the development of inflammatory bowel disease. In a new study published in Molecular Nutrition and Food Research that was conducted in mice, red meat consumption caused an imbalance of bacteria in the intestinal microbiota.
Investigators fed mice various kinds of red meat, including pork, beef, and mutton, for two weeks, and then they induced colitis with 2.5% dextran sulfate sodium. Intake of these three red meat diets exacerbated colonic inflammation. Analyses revealed an overproduction of pro-inflammatory cytokines and infiltration of immune cells in the colon of mice fed red meat diets.
These diets led to a marked decrease in the relative abundance of Streptococcus, Akkermansia, Faecalibacterium, and Lactococcus bacterial strains, coupled with an increase in Clostridium and Mucispirillum.
“This study contributes to improving food innervation approaches for inflammatory bowel disease treatment and indicates a close crosstalk among diet, gut microbiota, and intestinal immunity,” said co–corresponding author Dan Tian, MD, PhD, of Capital Medical University, in China.
Scientists have discovered why older people are more likely to suffer severely from the flu, and can now use their findings to address this risk. In a new study published in PNAS, experts discovered that older people produce a glycosylated protein called apoplipoprotein D (ApoD), which is involved in lipid metabolism and inflammation, at much higher levels than in younger people. This has the effect of reducing the patient’s ability to resist virus infection, resulting in a more serious disease outcome.
The team established that highly elevated ApoD production with age in the lung drives extensive tissue damage during infection to reduce the protective antiviral type I interferon response.
The research was an international collaboration led by scientists from the China Agricultural University, University of Nottingham, Institute of Microbiology (Chinese Academy of Sciences), National Institute for Viral Disease Control and Prevention (Chinese Centre for Disease Control and Prevention) and the University of Edinburgh.
Aging is a leading risk factor in influenza-related deaths. Furthermore, the global population is aging at an unprecedented rate in human history, posing major issues for healthcare and the economy. So we need to find out why older patients often suffer more severely from influenza virus infection.”
Professor Kin-Chow Chang from the School of Veterinary Medicine and Science at the University of Nottingham, and co-author on the paper
In this new study, the team investigated the mechanisms behind increased severity of influenza virus infection with age using an aging-mouse model and appropriate donor human tissue sections.
They identified ApoD as an age-related cell factor that impairs the activation of the immune system’s antiviral response to influenza virus infection by causing extensive breakdown of mitochondria (mitophagy) resulting in greater production of virus and lung damage during infection. Mitochondria are essential for cellular production of energy and for induction of protective interferons.
ApoD is therefore a target for therapeutic intervention to protect against severe influenza virus infection in the elderly which would have a major impact on reducing morbidity and mortality in the aging population.
Professor Chang, added: “There is now an exciting opportunity to therapeutically ameliorate disease severity of the elderly from influenza virus infection by the inhibitory targeting of ApoD.”
Disposable syringe of Clexane (enoxaparin), a low molecular weight heparin (LMWH). CC0
Researchers at McMaster University have discovered that a rare but dangerous reaction to heparin is caused by a single antibody – overturning decades of medical misunderstanding and opening the door to more precise ways of diagnosing and treating this medical complication.
The study, published in the New England Journal of Medicine, focused on heparin-induced thrombocytopenia (HIT), a serious immune complication that affects approximately one per cent of hospitalised patients treated with the blood thinner heparin. Nearly half of those who develop HIT experience life-threatening blood clots, which can lead to strokes, heart attacks, amputations, and even death, making early detection and treatment critically important.
Until now, scientists believed that the immune response causing HIT involved many different types of antibodies working together. But this research has revealed something surprising: in every patient studied, only one antibody was causing the disease, while the rest created what the researchers describe as a kind of “smokescreen,” making it harder to identify the true culprit. This discovery helps pinpoint the exact source of the problem, opening the door to more accurate diagnosis and better-targeted treatments.
“This study not only challenges our existing understanding of HIT but also revolutionises how we think about the immune response overall,” said Ishac Nazy, senior author of the study and scientific director of the McMaster Platelet Immunology Laboratory and co-director of the Michael G. DeGroote Center for Transfusion Research (MCTR).
“This work corrects decades of misunderstanding in HIT. This status quo was a key reason behind the high rate of false-positive test results and frequent misdiagnoses in HIT, which can lead to severe consequences for patients, including unnecessary treatment or avoidable complications. Our findings lay the groundwork for more accurate diagnostics and targeted treatments,” said Nazy, a professor in the Department of Medicine and the Department of Biochemistry and Biomedical Sciences at McMaster.
The research team was comprised of scientists from the McMaster Platelet Immunology Laboratory (MPIL) within MCTR as well as collaborators from the University of Massachusetts Amherst.
They analysed blood samples from nine patients diagnosed with HIT. In each case, they found that the antibodies targeting platelet factor 4 (PF4) – a protein involved in blood clotting – were monoclonal. This suggests that HIT may be driven by a highly specific immune reaction, rather than a generalised one.
“This discovery could reshape how we diagnose HIT and eventually how we treat it,” said Jared Treverton, first author of the study and a PhD candidate at McMaster. “Knowing that HIT is caused by a monoclonal antibody will allow us to develop improved tests specific to patients with this disorder and design better targeted therapies. This is a major step towards making diagnostics more accurate and treatments much safer.”
The findings are expected to have immediate relevance for haematologists, laboratory specialists, and researchers in immunology, as well as for patients receiving heparin in hospitals across Canada and around the world.
Study reveals that 1 in 10 will initiate opioid prescriptions long term.
Photo by Anna Shvets on Pexels
New research indicates that many patients who undergo surgery with the intent to cure early-stage cancer continue or start opioid prescriptions in the year following surgery. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
Pain management is essential during cancer care, but prescription opioid practices associated with cancer treatment may lead to unsafe long-term opioid use and adverse outcomes such as opioid use disorder and opioid overdose. To assess the situation, investigators examined rates of new persistent opioid use in the year following surgery for stage 0 to 3 cancers among 9213 U.S. Veterans who were opioid-naïve (not on prescribed opioids the year prior to their cancer diagnosis).
The team found that potentially dangerous co-prescription of opioid and benzodiazepine (a central nervous system depressant that treats anxiety, insomnia, and seizures and should not be combined with opioids) medications occurred in 366 (4.0%) Veterans during follow-up. Persistent opioid use occurred in 981 (10.6%). A higher intensity of exposure to opioid prescriptions during treatment was associated with these outcomes. People with a prior history of chronic pain, greater comorbidities, lower socioeconomic status, and who received adjuvant chemotherapy were at especially high risk of opioid use in the year after surgery.
“Minimising opioid exposure associated with cancer treatment while providing effective pain control will decrease long-term health risks among cancer survivors,” said lead author Marilyn M. Schapira, MD, MPH, of the University of Pennsylvania. “This is important as many patients are living longer after a cancer diagnosis and treatment.”
Study has implications beyond medical education, suggesting other fields could benefit from AI-enhanced training
Artificial intelligence (AI) is becoming a powerful new tool in training and education, including in the field of neurosurgery. Yet a new study suggests that AI tutoring provides better results when paired with human instruction.
Researchers at the Neurosurgical Simulation and Artificial Intelligence Learning Centre at The Neuro (Montreal Neurological Institute-Hospital) of McGill University are studying how AI and virtual reality (VR) can improve the training and performance of brain surgeons. They simulate brain surgeries using VR, monitor students’ performance using AI and provide continuous verbal feedback on how students can improve performance and prevent errors. Previous research has shown that an intelligent tutoring system powered by AI developed at the Centre outperformed expert human teachers, but these instructors were not provided with trainee AI performance data.
In their most recent study, published in JAMA Surgery, the researchers recruited 87 medical students from four Quebec medical schools and divided them into three groups: one trained with AI-only verbal feedback, one with expert instructor feedback, and one with expert feedback informed by real-time AI performance data. The team recorded the students’ performance, including how well and how quickly their surgical skills improved while undergoing the different types of training.
They found that students receiving AI-augmented, personalised feedback from a human instructor outperformed both other groups in surgical performance and skill transfer. This group also demonstrated significantly better risk management for bleeding and tissue injury – two critical measures of surgical expertise. The study suggests that while intelligent tutoring systems can provide standardised, data-driven assessments, the integration of human expertise enhances engagement and ensures that feedback is contextualised and adaptive.
“Our findings underscore the importance of human input in AI-driven surgical education,” said lead study author Bianca Giglio. “When expert instructors used AI performance data to deliver tailored, real-time feedback, trainees learned faster and transferred their skills more effectively.”
While this study was specific to neurosurgical training, its findings could carry over to other professions where students must acquire highly technical and complex skills in high-pressure environments.
“AI is not replacing educators – it’s empowering them,” added senior author Dr Rolando Del Maestro, a neurosurgeon and current Director of the Centre. “By merging AI’s analytical power with the critical guidance of experienced instructors, we are moving closer to creating the ‘Intelligent Operating Room’ of the future capable of assessing and training learners while minimising errors during human surgical procedures.”
Schizophrenia and bipolar disorder are serious mental illnesses that affect both males and females, but research in Acta Psychiatrica Scandinavica indicates that sex may influence the characteristics and course of these conditions.
The research included 1516 individuals from the multicentre PsyCourse Study: 543 with bipolar disorder, 517 with schizophrenia, and 456 healthy controls.
Several differences between groups and sexes were identified in age at diagnosis, age at treatment, illness duration, illicit drug use, and smoking. For example, females in the schizophrenia group were older than males at first outpatient treatment compared with females in the bipolar disorder group. Moreover, those who were older at first outpatient treatment presented a longer duration of illness. Regarding substance use, the highest rates were observed in males with schizophrenia. People with bipolar disorder showed better functioning and neurocognitive performance than those with schizophrenia. Among individuals with bipolar disorder, females reported better performance in verbal memory and psychomotor speed than males. Both females and males with serious mental illnesses showed higher rates of thyroid alterations than healthy controls.
“Our findings reveal a clear message: sex-sensitive treatment is essential for improving clinical outcomes, promoting healthy habits, and managing comorbidities,” said corresponding author Anabel Martinez-Arán, PhD, of the Hospital Clinic of Barcelona.
Preventing and managing high blood pressure with healthy lifestyle behaviours combined with early treatment with medication to lower blood pressure if necessary are recommended to reduce the risk of heart attack, stroke, heart failure, kidney disease, cognitive decline and dementia, according to a new clinical guideline published in the American Heart Association’s peer-reviewed journals Circulation and Hypertension, and in JACC, the flagship journal of the American College of Cardiology.
The “2025 AHA / ACC / AANP / AAPA / ABC / ACCP / ACPM / AGS / AMA / ASPC / NMA / PCNA / SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults” replaces the 2017 guideline and includes new or updated recommendations for blood pressure management based on the latest scientific evidence to achieve the best health outcomes for patients.
The new guideline reflects several major changes since 2017, including use of the American Heart Association’s PREVENTTM (Predicting Risk of cardiovascular disease EVENTs) risk calculator to estimate cardiovascular disease risk. It also provides updated guidance on medication options, including the early treatment for high blood pressure to reduce the risk of cognitive decline and dementia; use of specific medications including the possible addition of newer therapies such as GLP-1 medications for some patients with high blood pressure and overweight or obesity, and recommendations for managing high blood pressure before, during and after pregnancy.
High blood pressure (including stage 1 or stage 2 hypertension) affects nearly half (46.7%) of all adults in the U.S., is the leading cause of death in the U.S. and around the world. The blood pressure criteria remain the same as the 2017 guideline:
normal blood pressure is less than 120/80 mm Hg;
elevated blood pressure is 120-129 mm Hg and <80 mm Hg;
stage 1 hypertension is 130-139 mm Hg or 80-89 mm Hg; and
stage 2 hypertension is ≥140 mm Hg or ≥90 mm Hg.
“High blood pressure is the most common and most modifiable risk factor for heart disease,” said Chair of the guideline writing committee Daniel W. Jones, M.D., FAHA, dean and professor emeritus of the University of Mississippi School of Medicine in Jackson, Mississippi, and was a member of the writing committee for the 2017 high blood pressure guideline. “By addressing individual risks earlier and offering more tailored strategies across the lifespan, the 2025 guideline aims to aid clinicians in helping more people manage their blood pressure and reduce the toll of heart disease, kidney disease, Type 2 diabetes and dementia.”
“This updated guideline is designed to support health care professionals – from primary care teams to specialists, and to all clinicians across health systems – with the diagnosis and care of people with high blood pressure. It also empowers patients with practical tools that can support their individual health needs as they manage their blood pressure, whether through lifestyle changes, medications or both,” Jones said.
Importance of healthy lifestyle
The new guideline reaffirms the critical role healthy lifestyle behaviours play in preventing and managing high blood pressure, and it encourages health care professionals to work with patients to set realistic, achievable goals. Healthy behaviours such as those in Life’s Essential 8, the American Heart Association’s metrics for heart health, remain the first line of care for all adults.
Specific blood pressure-related guidance includes:
limiting sodium intake to less than 2,300 mg per day, moving toward an ideal limit of 1,500 mg per day by checking food labels (most adults in the U.S. get their sodium from eating packaged and restaurant foods, not the salt shaker);
ideally, consuming no alcohol or for those who choose to drink, consuming no more than two drinks per day for men and no more than one drink per day for women;
managing stress with exercise, as well as incorporating stress-reduction techniques like meditation, breathing control or yoga;
maintaining or achieving a healthy weight, with a goal of at least a 5% reduction in body weight in adults who have overweight or obesity;
following a heart healthy eating pattern, for example the DASH eating plan, which emphasizes reduced sodium intake and a diet high in vegetables, fruits, whole grains, legumes, nuts and seeds, and low-fat or nonfat dairy, and includes lean meats and poultry, fish and non-tropical oils;
increasing physical activity to at least 75-150 minutes each week including aerobic exercise (such as cardio) and/or resistance training (such as weight training); and
home blood pressure monitoring is recommended for patients to help confirm office diagnosis of high blood pressure and to monitor, track progress and tailor care as part of an integrated care plan.
Addressing each of these lifestyle factors is especially important for people with high blood pressure and other major risk factors for cardiovascular disease because it may prevent, delay or treat elevated or high blood pressure.
New risk calculator and earlier intervention
The new guideline recommends that health care professionals use thePREVENTTM risk calculator to estimate a person’s risk of a heart attack, stroke or heart failure. Developed by the American Heart Association in 2023, PREVENTTM is a tool to estimate 10- and 30-year risk of cardiovascular disease in people ages 30-79 years. It includes variables such as age, sex, blood pressure, cholesterol levels and other health indicators, including zip code as a proxy for social drivers of health. It is the first risk calculator that combines measures of cardiovascular, kidney and metabolic health to estimate risk for cardiovascular disease. More precise risk estimates can help guide treatment decisionspersonalized for each individual.
In addition to the use of the PREVENTTM risk assessment tool, the new guideline recommends two important changes to laboratory testing for initial evaluation.
The ratio of urine albumin and creatinine (a test that assesses kidney health) is now recommended for all patients with high blood pressure. It was recommended as an optional test in the 2017 guideline.
The guideline also expands the indication for use of the plasma aldosterone-to-renin ratio test as a screening tool for primary aldosteronism in more patients including those with obstructive sleep apnea. (Primary aldosteronism is a condition that occurs when the adrenal glands make too much aldosterone, leading to high blood pressure and low potassium levels.)
Screening for primary aldosteronism may also be considered in adults with stage 2 hypertension to increase rates of detection, diagnosis and targeted treatment.
Association of high blood pressure with cognitive decline and dementia
While high blood pressure is a leading cause of heart attack and stroke, the new guideline highlights other serious risks. More recent research confirms that blood pressure affects brain health, including cognitive function and dementia. High blood pressure can damage small blood vessels in the brain, which is linked to memory problems and long-term cognitive decline. The guideline recommends early treatment for people diagnosed with high blood pressure with a goal of systolic blood pressure (top number) goal of <130 mm Hg for adults with high blood pressure to prevent cognitive impairment and dementia.
Tailored approaches to medication for high blood pressure
For many people with high blood pressure, especially those who have Type 2 diabetes, obesity or kidney disease, more than one medication may be needed to lower blood pressure to meet the <130/80 mm Hg criteria. The guideline highlights several types of blood pressure medications to initiate treatment, including angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), long-acting dihydropyridine calcium channel blockers and thiazide-type diuretics. If blood pressure remains high after one medication, clinicians may individualize treatment to either increase the dose or add a second medication from a different medication class.
The guideline maintains the recommendation to begin treatment with two medications at once – preferably in a single combination pill – for people with blood pressure levels 140/90 mm Hg or higher (stage 2 hypertension). The guideline also suggests possible addition of newer therapies such as GLP-1 medications for some patients with high blood pressure and overweight or obesity.
High blood pressure and pregnancy
High blood pressure during pregnancy can have lasting effects on the mother’s health, including an increased risk of future high blood pressure and cardiovascular conditions. Without treatment, high blood pressure during pregnancy can lead to serious complications, such as preeclampsia, eclampsia, stroke, kidney problems and/or premature delivery. Women with high blood pressure who are planning a pregnancy or are pregnant should be counselled about the potential benefits of low-dose aspirin (81 mg/day) to reduce the risk of preeclampsia.
For pregnant women with chronic hypertension (high blood pressure before pregnancy or diagnosed before 20 weeks of pregnancy), the new guideline recommends treatment with certain medications when systolic blood pressure reaches 140 mm Hg or higher and/or diastolic blood pressure reaches 90 mm Hg or higher. This change reflects growing evidence that tighter blood pressure control for some individuals during pregnancy may help to reduce the risk of serious complications.
In addition, postpartum care is especially important because high blood pressure can begin or persist after delivery. The guideline urges continued blood pressure monitoring and timely treatment during the postpartum period to help prevent complications. Patients with a history of pregnancy-associated high blood pressure are encouraged to have their blood pressure measured at least annually.
“It is important for people to be aware of the recommended blood pressure goals and understand how healthy lifestyle behaviours and appropriate medication use can help them achieve and maintain optimal blood pressure. Prevention, early detection and management of high blood pressure are critical to long-term heart and brain health, which means longer, healthier lives,” said Jones.
By Fatima Hassan, Leena Menghaney, and Bellinda Nkoana
A new HIV prevention jab has the potential to bring an end to the AIDS epidemic. But a lack of ambition and unjustifiable secrecy over pricing is holding it back, argue three leading health activists.
Imagine a new HIV prevention tool existed that could – if it reached the right people – flick the switch to prevent almost all new HIV cases across the world. You would expect every health system and government to be doing all they can to roll it out to everyone as quickly as possible, regardless of the challenges, right?
The good news is that this scenario is not merely in our imagination because we actually have that tool today. The bad news? The rollout of this breakthrough HIV prevention jab is moving at a glacial pace.
Lenacapavir, a twice-yearly antiretroviral-containing injection, is one of the most promising tools yet in the fight to end AIDS. Data from two major trials released last year showed it offers near-complete protection against HIV infection for some of the most vulnerable groups: young women, men who have sex with men, sex workers, and transgender and gender-diverse people. Trials that test the effectiveness of the jab as prevention in people who inject drugs are also underway. For communities still bearing the brunt of new infections, it could be a game-changer.
Take South Africa as a case in point. Modelling studies suggest the impact could be transformative. If two to four million HIV-negative people here used lenacapavir annually over the next eight years, new infections could dramatically fall, with rates low enough that experts would consider it significant enough to end AIDS.
And yet, the current rollout targets look worryingly timid, particularly for vulnerable communities.
According to the National Department of Health, South Africa’s projected initial target for the first two years of the roll out (April 2026 – March 2028 and subject to registration or interim approval by the South African Health Products Regulatory Authority) of just under 500 000 people, includes the general population and certain vulnerable or key risk population groups – for the latter, the targets are woefully low: 69 799 sex workers, 37 857 transgender people, and 155 946 gay, bisexual, and other men who have sex with men.
This barely scratches the surface of the actual need in vulnerable populations. At this rate, access will be severely rationed, and the epidemic will continue to outpace us.
One reason the roll out cannot be on a mass scale, is not just due to an absent political will, but also because the company that holds the patent, Gilead Sciences, is rationing access. And until a sufficient number of generics come on to the market, voluntarily or through compulsory measures, Gilead will call the shots.
The Trump administration’s funding cuts earlier this year left ambitious plans to roll out lenacapavir in several countries in the Global South in the dust. In response, South Africa, in consultation with the Global Fund for AIDS, Tuberculosis, and Malaria (Global Fund) and indirectly with Gilead, announced plans to repurpose R520-million from an existing Global Fund grant to buy lenacapavir for HIV prevention.
But despite South Africa being asked by the Global Fund to budget $30 per dose ($60, roughly R1 050, per person per year) as its contribution, no one knows the total price the Global Fund is paying Gilead.
Such pricing secrecy is unacceptable, especially when health ministries in low- and middle-income countries are already squeezed by the massive US government funding cuts and debt crises.
Countries excluded from the Global Fund’s supply agreement and Gilead’s inadequate mechanisms for allowing generic competition (they exclude several countries and only a few companies were licensed) will be left to negotiate directly with Gilead, facing the prospect of unaffordable “tiered” prices designed to maximise profit – eerily similar to the COVID vaccine inequitable access debacle. Millions who need HIV prevention could face rationing, with health providers forced to leave the most vulnerable populations behind.
The Global Fund’s willing decision to shield Gilead’s pricing from public disclosure undermines accountability and risks reversing years of hard-won progress towards transparency in medicine pricing in the Global South and elsewhere. This is a dangerous precedent for the global HIV movement as pharmaceutical multinational companies are finding new ways to normalise price secrecy – and the Global Fund has just approved that tactic. While civil society in Global South countries such as South Africa are defending the right to know how public funds are spent, global institutions like the Global Fund in Geneva, are enabling practices that give pharmaceutical corporations a free pass.
The push to normalise secrecy, particularly when public or donor money is involved, should ring alarm bells. If international actors are serious about equitable access, then price transparency must be non-negotiable. Anything less erodes public trust and hands undue power to pharmaceutical companies at the expense of public health. Transparency is also necessary to ensure that the price we pay is fair and justified, because public money should not subsidise Gilead’s profiteering.
All this comes at a time when global health financing is under severe strain. Deep cuts in HIV/AIDS funding have already cost tens of thousands of lives across multiple countries. But rationing prevention is a false economy because the cost of new infections, in lives and long-term treatment, will far outweigh the investment required to scale up prevention now.
As delegates convene this week at the SA AIDS Conference, they must publicly call out the demand for price secrecy from Gilead and the Global Fund for what it is: bullying. It must also raise the funds, domestically and internationally, to pay for lenacapavir for all who need it. Two million people at minimum should be the national target – four times the glacial rollout pace the Global Fund is proposing at present.
The lesson from history is clear: When lifesaving HIV treatment was delayed, millions died needlessly. We cannot afford the same mistake with HIV prevention.
*Hassan, Menghaney, and Nkoana are all part of the global LEN-LA for All Coalition, a grouping that includes the organisations Health GAP, Health Justice Initiative, Sankalp Rehabilitation Trust, Just Tx, and ABIA.
Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.
