Health
State Department Permits Distribution of H.I.V. Medications to Resume — for Now
The Trump administration on Tuesday issued a waiver for lifesaving medicines and medical services, offering a reprieve for a worldwide H.I.V. treatment program that was halted last week.
The waiver, announced by Secretary of State Marco Rubio, seemed to allow for the distribution of H.I.V. medications, but whether the waiver extended to preventive drugs or other services offered by the program, the President’s Emergency Plan for AIDS Relief, was not immediately clear.
Still, PEPFAR’s future remains in jeopardy, with potential consequences for more than 20 million people — including 500,000 children — who could lose access to lifesaving medications. Without treatment, millions of people with H.I.V. in low-income countries would be at risk of full-blown AIDS and of premature death.
“We can very rapidly return to where the pandemic is exploding, like it was back in the 1980s,” said Dr. Steve Deeks, an H.I.V. expert at the University of California, San Francisco.
“This really cannot happen,” he said.
On Monday, the Trump administration ordered health organizations in other countries to immediately stop distributing H.I.V. medications purchased with U.S. aid. The directive stemmed from a freeze — which may become permanent — in the activities of PEPFAR, a $7.5 billion program overseen by the State Department.
Since it started in 2003, PEPFAR is estimated to have saved more than 25 million lives; more than 5.5 million children have been born free of H.I.V. who otherwise would have been infected.
In South Africa alone, PEPFAR’s shutdown would add more than a half million new H.I.V. infections and more than 600,000 related deaths over the next decade, according to one estimate.
The organization employs 270,000 doctors, nurses, pharmacists and other health workers. They had been told not to report to work or to serve patients.
PEPFAR’s end would “create instability and potentially collapse several countries’s AIDS programs that will be difficult to repair, if and when PEPFAR funding becomes available again,” said Dr. Salim Abdool Karim, an infectious disease epidemiologist at the University of KwaZulu-Natal in Durban, South Africa.
Dr. Abdool Karim said countries should stop relying on PEPFAR and support their own citizens, a goal that the program’s staff and partners had been working toward. But ideally that shift would happen gradually, over years during which PEPFAR would train local health workers and prepare them for the transition, he said.
“This is not a bad opportunity for countries to take greater responsibility,” he said. “But I think they can’t do it if it’s done in this kind of haphazard and unplanned way.”
Here’s what he and others expect from PEPFAR’s unexpected pause.
Sudden stops to H.I.V. treatment can quickly turn dangerous.
Every day, more than 220,000 people pick up H.I.V. medications at clinics funded by PEPFAR; the number included more than 7,400 children under 15, according to data published on Tuesday by AMFAR, The Foundation for AIDS Research.
The drugs work by suppressing H.I.V. in the body. When patients go off the drugs, the virus grabs the opportunity to rebound — and quickly. Within a week, H.I.V. levels will skyrocket from undetectable levels to more than 100,000 copies per milliliter of blood.
“That may be a time where you are very much at risk of passing the virus on to others,” Dr. Sallie Permar, a pediatrician and H.I.V. expert at Weill Cornell Medicine, said.
Then, the virus will start attacking a certain type of immune cell, crippling the body’s ability to fend off other infections, including tuberculosis, which frequently accompanies H.I.V. infection.
Spiking H.I.V. levels at first may cause flulike symptoms, including sore throat, swollen glands and fatigue. The immune system will likely marshal enough force to suppress the virus temporarily, but H.I.V. is adept at hiding until it finds the right opportunity to re-emerge.
When that occasion arises, “they can develop AIDS and progress,” Dr. Deeks said.
Children may be among the hardest hit.
PEPFAR is best known for financing H.I.V. treatment programs, but its funds also go to drugs for prevention, outreach and testing, and to support for orphans and women experiencing gender-based violence.
The loss of resources for each of these efforts will derail the fight against AIDS, said Dr. Glenda Gray, a pediatric H.I.V. expert at Wits University in South Africa.
“If H.I.V. testing falls by the wayside, it’s unlikely that we will be able to even diagnose people who need to go into treatment,” she said.
If a pregnant or breastfeeding woman has H.IV. but is not tested and not treated, she may pass the virus to her child. The higher her viral load, the more likely this is to occur.
Children with H.I.V. are less likely to be diagnosed than adults, and may not be treated till the virus makes them visibly very sick. This progression can be much more rapid in children than in adults, Dr. Gray said, “and obviously, children who are untreated are likely to die.”
Inconsistent treatment drives drug resistance.
As people lose access to medications, they may try to spread out their supplies by alternating days or to share their pills with others. If the virus replicates in people with only partial protection, it can learn to evade those defenses and become resistant to the medications.
People living with the virus may then pass the resistant virus on to others.
“That becomes a big problem, because now, suddenly, our cheap first-line drugs might not work when we have to restart them on treatment,” Dr. Abdool Karim said.
A virus that is resistant to treatments will also be better at evading vaccine candidates being tested.
“Not only are we looking at more drug resistance, but we’re looking at losing whatever ability we had to make an effective vaccine,” Dr. Permar said.
PEPFAR’s end may affect Americans, too.
More than one million Americans are living with the virus, and more than 30,000 become infected each year. If H.I.V. becomes resistant to available medications, it isn’t likely to remain in low-income countries. Americans, too, will be at risk.
They may also face indirect harms from ending PEPFAR. Creating huge populations of immunocompromised people may mean that other pathogens have an opportunity to spread. For example, dangerous Covid variants, including Omicron, are thought to have evolved in immunocompromised people with H.I.V.
At the same time, people worldwide have benefited from trials conducted under PEPFAR’s auspices, showing the importance of treating H.I.V. early, demonstrating that pregnant women can safely breastfeed as long as they are treated and that H.I.V. infections can be prevented with long-acting drugs.
“America has gotten an amazing amount of love around the world because of what it’s done,” Dr. Deeks said.
“From a humanitarian perspective, I can’t imagine anyone really wants to go along this pathway,” he added. “This doesn’t make any sense on any level.”
Congratulations, you’ve reached the final day of the Brain Health Challenge! Today, we’re asking you to do a few things that might feel a bit out of left field — like getting your blood pressure checked.
No, it isn’t as fun as playing Pips, but experts say it’s one of the most important things you can do for your brain. That’s because heart health and brain health are intrinsically linked.
High blood pressure, in particular, can damage brain cells, and it’s a significant risk factor for stroke and dementia. When blood pressure is too high, it places stress on the walls of arteries in the brain. Over time, that added stress can cause the blood vessel walls to thicken, obstructing blood flow. In other cases, the increased pressure causes the artery walls to thin and leak blood into the brain.
These changes to the blood vessels can sometimes cause a large stroke to occur. More commonly, the damage leads to micro-strokes and micro-hemorrhages, which cause fewer immediate problems and often go unnoticed. But if someone has hypertension for years or decades, these injuries can build up, and the person may start to experience cognitive impairment.
High blood pressure “is known as a silent killer for lots of reasons,” said Dr. Shyam Prabhakaran, the chair of neurology at the University of Chicago. “It doesn’t cause you any symptoms until it does.”
Because the damage accumulates over many years, experts say that managing blood pressure in midlife matters most for brain health. Hypertension can be addressed with medication or lifestyle changes, as directed by your doctor. But the first thing you need to do is know your numbers. If your blood pressure comes back higher than 120/80, it’s important to take it seriously, Dr. Prabhakaran said.
While you’re at it, there are a few other aspects of your physical health that you should check on.
Your eyes and ears are two of them. Hearing and vision loss have both been shown to increase the risk of dementia. Experts think that with less sensory information coming in to stimulate the brain, the regions that process hearing and vision can start to atrophy. What’s more, people with sensory loss often withdraw or are left out of social interactions, further depriving them of cognitive stimulation.
Oral health can also affect your brain health. Research has found a connection between regular flossing and reduced odds of having a stroke. That may be because good oral health can help to reduce inflammation in the body. The bacteria that cause gum disease have also been tied to an increased risk of Alzheimer’s.
And have you gotten your shingles vaccine? There is mounting evidence that it’s a powerful weapon for protecting against dementia. One study found that it lowered people’s odds of developing the condition by as much as 20 percent.
To wrap up this challenge, we want you to schedule a few medical appointments that benefit your brain, as well as your body.
After five days of feeding, exercising and challenging your brain, you are well on your way to better cognitive health. Thanks for joining me this week, and keep up the good habits!
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The Trump administration has taken a new approach to the food pyramid.
The Department of Health and Human Services (HHS) announced new guidelines on Wednesday with an updated, inverted pyramid. The top of the pyramid, which is now the wider part of the structure, is built on meat, fats, fruits and vegetables, while whole grains are at the narrow bottom.
This follows HHS Secretary Robert F. Kennedy Jr.’s mission to “Make America Healthy Again” (MAHA), aimed at addressing chronic disease, childhood illnesses and ultraprocessed foods.
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“The new guidelines recognize that whole, nutrient-dense food is the most effective path to better health and lower health care costs,” Kennedy said during a press briefing in Washington, D.C.
“Protein and healthy fats are essential, and were wrongly discouraged in prior dietary guidelines. We are ending the war on saturated fats.”
The Trump administration announces the 2025-2030 Dietary Guidelines for Americans, putting “real food” back at the center of health. (realfood.gov)
The HHS secretary rallied against refined carbohydrates, food additives and added sugar, highlighting the health risks associated with sugar-sweetened beverages.
Kennedy’s main message to Americans was to “eat real food.”
TRUMP ADMIN’S NEW NUTRITION GUIDELINES TARGET ULTRA-PROCESSED FOODS, EASE UP ON RED MEAT AND SATURATED FATS
The announcement triggered reactions from top health and wellness voices, including Stanford neuroscientist Dr. Andrew Huberman, host of the “Huberman Lab” podcast.
In a post on X, Huberman shared the White House’s graphic of the new pyramid, praising the decisions that were made.
“Oatmeal (and I think that’s rice and sourdough) made the cut!” he commented. “In all seriousness, assuming overall calories are kept in check and people exercise & get sun(day)light, this looks spot on.”
He added, “Maybe up the veggies a bit, add low-sugar fermented foods like sauerkraut & this is great.”
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Huberman said in a thread on the same post that Americans “don’t have to eat all the foods” shown in the diagram.
“You won’t see me drinking milk or eating shrimp,” he said. “Nothing against shrimp, I just don’t like the taste. Aversion to crustaceans.”
“Maybe up the veggies a bit, add low-sugar fermented foods like sauerkraut & this is great,” Huberman commented on X. (Chance Yeh/Getty Images for HubSpot; iStock)
The new guidelines received praise from other major health figures, including former FDA commissioner Dr. David Kessler.
“There should be broad agreement that eating more whole foods and reducing highly processed carbohydrates is a major advance in how we approach diet and health,” Kessler told The Associated Press.
“Protein and healthy fats are essential, and were wrongly discouraged in prior dietary guidelines.”
Dr. Bobby Mukkamala, president of the American Medical Association, shared in a statement that these guidelines “affirm that food is medicine and offer clear direction patients and physicians can use to improve health.”
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“The American Medical Association applauds the Administration’s new Dietary Guidelines for spotlighting the highly processed foods, sugar-sweetened beverages and excess sodium that fuel heart disease, diabetes, obesity and other chronic illnesses,” Mukkamala wrote.
The American Medical Association applauded the HHS for its updated nutrition guidelines. (iStock)
But not all feedback was positive.
Some people expressed concern about prioritizing red meat and dairy, while calling for the limitation of saturated fat.
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Neal Barnard, president of the Physicians Committee for Responsible Medicine, shared in a reaction to STAT that while the guidelines “do have one or two good points, emphasizing fruits and vegetables and limiting alcohol,” the guidelines are “for the most part a strong reflection of industry influence.”
Christopher Gardner, a nutrition expert at Stanford University, also spoke out against the new guidelines, as reported by NPR.
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“I’m very disappointed in the new pyramid that features red meat and saturated fat sources at the very top, as if that’s something to prioritize. It does go against decades and decades of evidence and research,” said Gardner, who was a member of the Dietary Guidelines Advisory Committee.
Fox News Digital’s Rachel Wolf, as well as Alexandria Hoff of Fox News, contributed reporting.
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