In this issue:
Activist named new health commissioner
CARE Act renewal bill introduced
Viral load determines transmission risk
Scientists envision anti-AIDS creams
Taste of drugs a barrier to adherence
"Invisible" condom prevents STDs in study
S. Africa defends alternative AIDS theories
Florida inmates help test HIV drugs
Walter Tsou, MD, a nationally-known public health activist and supporter of national health insurance programs, was named by Mayor John Street as Philadelphia's new health commissioner on March 27th.
Tsou, who formerly worked as a staff physician in the city's health centers, has for the past nine years been medical director of the Montgomery County Health Dept. He will assume his responsibilities as commissioner of the Philadelphia Department of Public Health on April 26th.
Walter Tsou, 47, of Mount Airy, is an internist and a well-regarded public-health physician. In his last job in Philadelphia, he helped start the citywide mammogram screening program. His hands-on experience in the Montgomery County Health Department includes an initiative to immunize all seventh graders against hepatitis B.
"Dr. Tsou is a recognized public-health expert who has a solid grasp of the issues, the needs, the funding streams, and the state and federal regulatory requirements," Street said. "He has demonstrated clinical expertise - but more than that, a clear commitment to serving inner-city communities."
Tsou will report directly to former Health Commissioner Estelle Richman, who has taken the new post of Director of Social Services in the Street Administration.
Tsou's responsibilities will be significantly more circumscribed than those held by Richman when she held the health commissioner's post. He will oversee the city's health centers, infectious disease programs, environmental health, and the city's nursing facilities and prison health programs, but will not be responsible for oversight of the behavioral health programs which have been part of the health department for most of its existence. Street has agreed to separate the three major behavioral health programs of the city - the Office of Mental Health and Mental Retardation, the Coordinating Office of Drug and Alcohol Abuse Programs, and Community Behavioral Health, the city's Medicaid managed care company - into a separate department to be called the Behavioral Health System. Richman will continue to manage the Behavioral Health System until a permanent director is hired.
Tsou has high visibility among his public-health colleagues. He founded a group dedicated to public health at the College of Physicians of Philadelphia and is an executive board member of the American Public Health Association.
During the decade he spent in the Philadelphia Health Department, Tsou rose from a clinician in a district health center to a medical program specialist with the department's ambulatory health services.
He has written and spoken extensively in favor of a single-payer national health-insurance system. He supports a "basic benefit" program for all Americans, including inpatient hospitalization, laboratory tests and pharmaceuticals. He serves as cochair of the Philadelphia chapter of Physicians for a National Health Program.
In an interview with the Philadelphia Inquirer, Tsou said that high on his priority list would be finding ways to expand access to care to the thousands of Philadelphians without health insurance. He said he would talk with health-care providers throughout the city, "seeking some type of general consensus how each can contribute to access to care that is within their own control."
A graduate of Abington High School, Tsou received his undergraduate and medical degrees from the University of Pennsylvania. He also has a master's degree in public health from Johns Hopkins University.
Tsou will be paid $125,000 a year and will oversee a department with 900 employees and a budget of $116 million.
"We are losing a very talented public-health advocate," said Robert Gage, the director of the Montgomery Department of Health. "We are losing someone who speaks with a clear and forceful voice on many important policy issues, including universal health coverage and the bolstering of the public-health infrastructure."
Lewis D. Polk, a former city health commissioner and now director of the Bucks County Health Department, said Tsou would not be a "caretaker" commissioner.
"He is someone who can make a difference," Polk said of Tsou. "Estelle Richman moved the Health Department in new and useful ways, and Walter will continue and build." (Philadelphia Inquirer)
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CARE Act renewal bill introduced
Rural and other underserved areas would receive more funds to fight AIDS and HIV under legislation introduced in the Senate on March 29th.
A bipartisan group of senators, led by Health, Education, Labor and Pensions Committee Chairman James Jeffords (R-VT) and Edward Kennedy (D-MA), introduced the bill to reauthorize and revise the 1990 Ryan White AIDS Care Act.
"With this reauthorization, we mark the 10 years through which the Ryan White CARE Act has provided needed healthcare and support services to HIV-positive people around the country," said Jeffords in a speech on the Senate floor. "Ryan White program dollars provide the foundation of care so necessary in fighting this epidemic."
Added Kennedy, who co-wrote the original measure, "While we have come a long way, we still face major challenges in responding to this devastating disease, no state by itself can provide the significant resources to help persons living with HIV disease obtain the medical and support services they need. The Ryan White CARE Act is indispensable."
While the original program was aimed primarily at the urban areas hardest hit by the AIDS epidemic, the new bill would double the minimum base funding available to states, as well as provide a new supplemental state grant to target aid to rural and underserved areas. The new programs, said Jeffords, will help not only those with AIDS, but those living with HIV that has not yet developed into AIDS.
The measure would also expand the AIDS Drug Assistance Program (ADAP), in recognition of the fact that new classes of antiretroviral drugs and people living longer have put more pressure on available funding. In Pennsylvania, ADAP funding is allocated to the Special Pharmaceutical Benefits Program.
Companion House legislation, being drafted by Rep. Tom Coburn (R-OK), a physician, is expected to be introduced next week.
Other sponsors of the Senate legislation includes Sens. Bill Frist (R-Tenn.), Christopher Dodd (D-Conn.), Orrin Hatch (R-Utah), Jeff Bingaman (D-N.M.) and Paul Wellstone (DFL-Minn.).
The CARE Act legislation would provide continued funding for medications, medical care and support services for people living with HIV/AIDS, in addition to addressing the needs of low income urban and rural communities, women and minorities.
"We know that the CARE Act has made a difference not only in the lives of persons with HIV/AIDS, but also in the lives of countless loved ones who have seen despair turn to hope through the support of CARE Act services. I look forward to early action by Congress this year to pass this needed legislation," Kennedy said.
Saying that the CARE Act would continue to enhance the lives of people affected by the disease, Human Rights Campaign Political Director Winnie Stachelberg said, "We must continue our efforts to ensure access to [support and medical] services is available for those living with HIV/AIDS, particularly those in hard to reach communities, including communities of color, women and people living in rural areas where health disparities exist." She noted that the act "has proven to be effective [as a] response to HIV/AIDS, and its future must be protected," adding, "[we] look forward to continuing our work with Congress and the administration on a swift, bipartisan and positive reauthorization of the CARE Act."
The conservative group Independent Women's Forum, however, is urging the Senate to reject the CARE Act, charging that the proposed bill is "inadequate and ill-considered." Arguing that because the CDC fails to track HIV cases, the CARE Act is a "bogus public health program, disastrous to minority women, who are the newest [HIV] victims," the IWF encourages Congress to add "[proven public health measures," such as partner notification, HIV tracking and demographic-based funding, to the legislation. The IWF recommends that Congress "reject a Ryan White CARE Act that ignores addressing proven prevention strategies or fair funding formularies," charging that maintaining the status quo bill would be a "fatal mistake."
Meanwhile, President Clinton has asked Congress to add $100 million to the FY 2000 budget for payments to hemophiliacs who contracted HIV through tainted blood products between July 1982 and December 1987.
The funds would increase total FY 2000 budget allocations to $175 million for the Ricky Ray Hemophiliac Relief Fund Act, which authorized establishment of a trust fund for hemophiliacs with HIV. Most of the funds would come from the budget surplus. (Reuters, Kaiser Daily HIV/AIDS Report)
Viral load determines transmission risk
The single factor that most strongly predicts who will pass HIV on to a sexual partner is the level of the virus in the infected person's blood, according to a four-year study of more than 7,500 heterosexual married couples in Uganda.
"What we found is that the level of HIV in an individual predicts their infectiousness," study director Dr. Thomas Quinn of the Johns Hopkins Medical Institute in Baltimore said in an interview. "If we can lower that level by whatever means, then we can lower the spread of the epidemic effectively." The high cost of drugs that can lower HIV levels generally puts them out of reach in African nations where AIDS is a pandemic.
This study, done in collaboration with Dr. David Serwada's team at Makerere University in Kampala, Uganda, is a landmark, experts say, because it is the first to follow over time married couples in which one partner was HIV positive, the other HIV negative.
The couples, in the rural Rakai District of Uganda, were not only monitored but also aggressively treated for other sexually transmitted diseases, such as syphilis, and given free condoms.
Earlier studies conducted both in Africa and the United States had indicated that other factors-chiefly, lack of male circumcision and the presence of other sexually transmitted diseases-played key roles in making sex partners vulnerable to HIV infection. But this new study, details of which appear in the New England Journal of Medicine, shows that the influence of those factors pales when compared with the level of virus in the blood.
"For every 10-fold rise in the concentration of HIV in the bloodstream, transmission more than doubled," Quinn said.
At the National Institute of Allergy and Infectious Diseases, director Dr. Anthony Fauci said, "The findings uphold the strategic benefit of lowering levels of HIV in the blood...[to] help reduce heterosexual transmission of HIV, the predominant way AIDS is spreading in Africa and many parts of the world." But the cost of the so-called drug cocktails used in the United States averages more than $20,000 a year for the medicines and accompanying care.
In an editorial in today's New England Journal of Medicine, Dr. Marcia Angell, editor of the Journal of the Medical Association, attacks the study, accusing the researchers of unethical behavior. Angell argues that the sorts of drug cocktails used in the United States should have been provided by the researchers to the Ugandan couples-or else, she says, the study should not have been done. "Our ethical standards should not depend on where the research is performed," she said.
But the study, Quinn insists, was designed to test the hypothesis that aggressive treatment of other sexually transmitted diseases - not of HIV - would lower the risk of transmission of the AIDS virus. All study participants got state-of-the-art treatment for sexually transmitted diseases.
To address the situation, Quinn said, "we should be talking to pharmaceutical companies now to promote development of affordable drugs ... and that's going to take a concerted effort.
Anything that even slightly lowers the levels of HIV in the blood or genitals of infected individuals could have dramatic public health benefits, he argues. (Newsday)
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Scientists envision anti-AIDS creams
The first laboratory model of the female genital tract to shed light on how women become HIV-infected during sex is fueling hopes that new prophylactic creams can be developed to prevent the spread of AIDS, researchers said on March 28th.
Scientists at the University of Pittsburgh and Northwestern University have already shown that only a small amount of the anti-AIDS drug, PMPA, completely blocks HIV transmission when applied to human cervical tissue.
With a grant from the National Institutes of Health, researchers are about to begin tests on three other unidentified drugs which they hope will prove equally effective.
``A model such as this is long overdue in understanding the virologic and host factors involved in HIV transmission in women,'' said University of Pittsburgh microbiology professor Phalguni Gupta.
``The main route of HIV transmission has always been sexual, and heterosexuals are quickly becoming the target HIV-positive population, particularly in third-world countries.''
The new model, detailed in the journal Nature Medicine, uses tissues provided by otherwise healthy women who undergo reproductive surgical repair.
Earlier AIDS-transmission models have relied on only a single layer of cells, Gupta said. But the new model provides the natural tissue architecture of the female genital tract including epithelial cells, submucosa and immune cells.
Researchers place non-cellular HIV on top of a thumbnail-size piece of squamous cervical tissue and look to see how much of the virus penetrates to the bottom.
Gupta plans to develop a model using rectal tissue that can be used to study HIV transmission between homosexual men.
Such models also can be used to study different strains of HIV as well as other sexually transmitted diseases.
``This is the only system that tests not only the effectiveness but the toxicity of drugs people might think of using in creams or suppositories,'' he said.
PMPA, an experimental reverse transcriptase inhibitor developed by California-based Gilead Sciences Inc., was found to block HIV transmission without signs of toxic reaction, Gupta said.
Researchers believe the drug prevented the AIDS virus from replicating. Scientists at Northwestern University were studying the results of the test to determine exactly how the drug worked.
Taste of drugs a barrier to adherence
The innate desire to taste food and derive pleasure from that sensation is so strong that people sometimes stop taking life-saving medication simply because it tastes bad or ruins the flavor of otherwise enjoyable foods, according to Duke psychologists Susan Schiffman and Jennifer Zervakis. In a series of studies analyzing the taste effects of certain medications, Schiffman and her colleagues found that specific drugs used to treat AIDS, heart disease and depression either had a foul taste or significantly distorted the flavor of foods, a finding they say accounts for why some patients fail to take medications as recommended.
Just a short lapse in taking a prescribed medication can have dramatic health consequences for some patients, said Schiffman; for example, enabling the human immunodeficiency virus (HIV) to reach dangerously high levels or to build resistance against drugs used to fight it. In one extreme case, a patient of Schiffman's found his AIDS medications so bitter and unpalatable that he refused to take them and consequently died.
Findings from their studies on the taste properties of drugs, funded by the National Institutes of Health, were prepared for presentation at the American Chemical Society's annual meeting March 27- 30 in San Francisco.
"Distortions in taste and smell are far more than a nuisance, especially for patients whose conditions necessitate proper nutrition and a tightly controlled medication regimen," said Schiffman."Patients with sensory distortions can suffer from malnutrition, accidental poisonings, and chronic diseases like hypertension and diabetes that require the ability to taste, and thus regulate, salt or sugar intake."
In their current studies, Schiffman and Zervakis examined the taste impact of 63 different medications by applying them topically to the tongue's surface, a process that mimics how the drug is secreted in the saliva but does not allow it to enter the bloodstream.
Among the drugs Schiffman and Zervakis analyzed were protease inhibitors and nucleoside analogs, two commonly prescribed classes of AIDS drugs used to reduce viral loads and stave off the onset of symptoms. Schiffman found that three of the protease inhibitors -- indinavir, ritonavir and saquinavir -- were described by study subjects as bitter, medicinal, metallic, astringent, sour and burning. All off the nucleoside analogs in the study -- didanosine, lamivudine, zidovudine and stavudine -- were perceived as having the same unpleasant tastes, as well.
Patients with HIV (but not taking medications) perceived the drugs as being more bitter than did the subjects without HIV, suggesting that the disease process itself altered taste perception to some degree.
While unpleasant physical side effects are a common cause for patients to halt their medications, Schiffman said taste impairment is one effect that has received little attention but is a now emerging as a critical factor in compliance. Indeed, several recent studies conducted around the nation have documented the noncompliance rate due to taste distortions.
In a 1998 study of AIDS patients receiving care at five urban sites, 18 percent of 248 patients stopped taking their initial protease inhibitors because of taste alteration, according to a report by a team of researchers at the 12th World AIDS Conference in Geneva.
In another study, conducted in 1998 by Schiffman and colleagues at Duke, they found that 67 percent of HIV- infected patients taking a variety of medications had complaints about their sense of taste, and 47 percent reported problems with their sense of smell.
"The senses of taste and smell are often overlooked as second- class citizens to the more obvious senses of sight, hearing and touch, but their loss or distortion can have equally devastating consequences as do the loss of sight, hearing and touch," Schiffman said.
Elderly people are at particular risk for taste and smell deficits because of their advanced age and the multitude of diseases from which they suffer. The sheer quantity and interaction potential of the drugs they take can further compound taste loss and distortions.
Such is one concern with certain anti- depressants and heart medications commonly prescribed in the elderly, Zervakis and Schiffman's current studies found. Not only did the drugs taste bitter, but they also altered taste perception of other foods to a significant degree.
Subjects tasting the heart drug captopril reported a reduction in the intensity of sweet, salty and bitter tastes, while the heart drug procainamide increased the intensity of spiciness. All nine of the heart drugs studied were described as being predominantly bitter, with other negative qualities including metallic, medicinal, sour, sharp and astringent.
The four tricyclic anti- depressants Schiffman and Zervakis studied produced similar taste complaints among all subjects, old and young. However, elderly patients required as much as seven times more of certain drugs than younger patients did before they could taste it.
Zervakis said taste distortions and deficits like these put all patients at risk, but particularly the elderly, for stopping critical medications and for consuming excess sugar, salt and spoiled foods they cannot adequately taste. Additionally, she said, many drugs cause foods to become unpalatable for patients, which affects not only nutrition, but mood and well being. Without taste and smell, elderly or sick people are unable to select appropriate food and portion sizes, and they eventually lose the primary reinforcement to eat -- the pleasure derived from tasting and smelling food, Schiffman said. That pleasure takes on particular importance among people for whom other sources of gratification, such as work, family and hobbies, may be limited.
While few, if any, treatments exist to restore taste and smell, Schiffman has been able to block the bitterness of some drugs by adding sweeteners, sodium chloride (table salt) and polydextrose (a food thickener). Schiffman has also found that adding flavored powders like beef, bacon and cheese to a variety of foods can significantly increase the flavor and enjoyment of a meal among patients with taste loss.
In their upcoming research efforts, Schiffman and Zervakis will test ways to alter the biochemical process of taste by changing the taste cells' signaling mechanisms. (Doctor's Guide)
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"Invisible" condom prevents STDs in study
A "thermoreversible gel formulation," trademarked the Invisible Condom, may offer a new nontoxic approach to blocking infection with HIV, herpes simplex virus (HSV) and other sexually transmitted diseases, according to a report presented at the Microbicides 2000 meeting on March 15th.
"The purpose is to use this gel as a physical barrier" against STD infection, Dr. Michel J. Bergeron of Laval University in Quebec City, Canada, explained to his colleagues. To increase its effectiveness, Dr. Bergeron's group incorporated sodium lauryl sulfate (SLS) into the gel formulation. SLS is a detergent with minimal toxicity and also denatures the membrane proteins of the pathogen, he continued.
When the investigators incubated various strains of HSV with SLS, they found that HSV showed decreased infectivity to Vero cells in a concentration-dependent manner. Upon examination with electron microscopy, HSV-infected cells also "showed capsid shells devoid of DNA core in the nuclei."
In a mouse model, the gel prevented intravaginal infection with HSV-2. The researchers detected no HSV-2 upon examination of the vaginal mucosa of the treated mice.
Dr. Bergeron's team also found that SLS potently inhibited HIV infection in 1G5 cells.
In rabbits that received daily intravaginal applications of the gel over a 2-week period, no evidence of ulceration or necrosis associated with SLS was detected.
"Taken together," Dr. Bergeron believes, "these results indicate that the thermoreversible gel containing SLS as a microbicide could represent an innovative preventive measure to reduce the sexual transmission of HIV, herpes and possibly other sexually transmitted pathogens." (Reuters)
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S. Africa defends alternative AIDS theories
South African President Thabo Mbeki on March 24th defended his links with a controversial scientist who has incurred the wrath of international AIDS experts by questioning the causal link between HIV and AIDS.
A statement issued by Mbeki's office attacked local media for criticizing talks he had in February with David Rasnick, a US-based researcher who questions the widely accepted evidence that HIV infection causes AIDS.
"Government is strong in its resolve that we cannot confine our response to the problem of HIV/AIDS to an injunction not to speak to David Rasnick or telling people how to think," the statement read in part. "Whether we speak to Rasnick or not, whether there are thought police to monitor what others think, human beings will continue to die from AIDS."
South Africa has one of the highest rates of HIV infection in the world with an estimated 1,700 new infections each day. According to the government's own statistics, about 10% of the country's 40 million population is HIV-positive.
South African newspapers argue that Mbeki's contact with Rasnick could give his theories credibility and jeopardize South Africa's efforts to stem the spread of the epidemic.
Presidential spokesman Parks Mankahlana said that Mbeki had spoken to Rasnick and other researchers worldwide as part of his effort to gain a variety of insights into the disease. "He is being condemned for soliciting different views...Why should the president speak to certain people and not to others?" Mankahlana told Reuters.
Mbeki has been embroiled in several controversies over his government's AIDS policy since he succeeded former President Nelson Mandela last June. Last October, Mbeki, already under pressure to make the antiretroviral drug AZT available to thousands of rape victims, was criticized by AIDS groups when he questioned the efficacy of the drug in preventing HIV infection and reducing the rate of vertical transmission.
Mbeki's office said that the government could not afford the 4,000 rand ($616) per person per month needed for the combination drug anti-HIV regimen and accused pharmaceutical firms of collusion with the media in their criticism of the government's policies.
"President Mbeki is going to intensify the fight to [end] discrimination against and exploitation of people who live with HIV/AIDS, both by insurance and medical schemes, and the pharmaceutical giants who are the sole beneficiaries in the dogged defense of AZT by large sections of the media," Mbeki's office said. (Reuters)
A Philadelphia community behavioral healthcare center has won national recognition for a program that works with area individuals who have a mental health disorder and HIV/AIDS diagnosis.
COMHAR, Inc., will be presented the Special Program for Adults Award for its Community Living Room (CLR) program at the National Council for Community Behavioral Healthcare's annual training conference, April 29 to May 2, in Washington, DC.
Established in 1995, the CLR is one of 11 projects nationwide created to provide integrated mental health and HIV/AIDS services. The program was initially funded by the Center for Mental Health Services, of the U.S. Department of Health and Human Services.
The CLR's annual average client treatment cost ($1,236) is the lowest of the 11 projects. The program initially received federal funding for four years until 1998. When the federal funding expired, the Philadelphia County Office of Mental Health stepped in to continue the program because of its positive impact on the community.
The CLR works with a population that traditionally has been unengaged in mental healthcare, and HIV/AIDS services - individuals who are living in a low socio-economic environment. It was the only one of the federal projects that used a consumer-driven, psychosocial rehabilitation model that was fully within the community and not affiliated with a hospital or university. The CLR continues today as the only program of its kind in Philadelphia.
Members are provided with educational and skill-creating opportunities, which assist them in building healthier and more rewarding lives, in an atmosphere that makes them feel engaged and welcome. Groups and workshops that members may attend include: Mental health and HIV/AIDS education focusing on issues such as illness management, risk prevention, medications, and nutrition;
Skill enhancement for daily living, communication, leisure time, and inter- and intra-personal skills; creativity and self expression through art , music, writing, and drama; insight development into relationships, sexuality, goal setting, and decision making; and complementary and holistic therapies such as yoga and meditation.
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Florida inmates help test HIV drugs
Dozens of inmates at a Central Florida prison are being treated for HIV and AIDS with combinations of medications that could have unknown dangers, a newspaper reported.
Some worry prisoners don't fully understand the risks or may be pressured to become research subjects, but many prisoners say the research has greatly improved their health, the St. Petersburg Times reported.
At issue is a voluntary testing program at the South Unit of the Central Florida Reception Center, 10 miles east of Orlando International Airport. The facility is among only a handful of the nation's prisons to allow such research.
There, free drugs and health exams are available for prisoners whose care would otherwise cost the state thousands of dollars per inmate per year.
Under the study rules, HIV-positive inmate volunteers get combinations of more than a dozen drugs. The aim is to see which drugs work best in which doses for which kinds of patients, Department of Corrections officials said.
Many inmates said the drugs have greatly improved their lives.
That includes Julius Samuel, 44, a burglar with HIV who was losing weight before going on the drug regimen.
"They have more drugs at the South Unit than where I was at," Samuel said. "I don't have a trace of the virus."
The drug testing program is relatively new. For years, the Florida prison system did not use inmates as subjects in medical experiments. Many states, including Florida, banned the practice after revelations in the 1970s that researchers working for drug companies exploited inmates in the name of science or profit.
That changed during the AIDS epidemic of the 1980s. Gravely ill people, including Florida inmates, began demanding access to experimental therapies that might save their lives.
A Florida prison official lifted the research ban on inmates and in December 1997, Margaret Fischl, a pioneering AIDS researcher, was allowed to set up a screening and testing site at the South Unit.
The prison system told her that inmates had to receive good treatment and couldn't take part in initial experiments to determine whether a drug is toxic.
But despite signing consent papers, some inmates do not seem particularly well informed about potential risks of the drugs, the newspaper reported.
Raymond McGee, 31, a former inmate now living at an Orlando halfway house, said he never asked, nor was told, about details of what the consent form calls a "potentially life-threatening" hypersensitivity reaction that the drug, abacavir, sometimes causes.
That can include fever, fatigue and skin rash.
Still, McGee says he's not concerned.
"I never had a reaction to it," he said. "If I didn't think it was working, I'd stop taking it."
Fischl said the combinations she gives inmates have successfully reduced the virus without negative impacts. Prisoners have had fewer adverse reactions than non-prisoners participating in the clinical trials, she said.
Fischl and Department of Corrections officials said that inmates are under no pressure to volunteer.
"There is no coercion," said David L. Thomas, the prisoner system's director of health services.
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New hepatitis link found
Researchers in Italy think they may have found the last missing piece of the hepatitis puzzle. Daniele Primi, M.D., of DiaSorin, Inc., a biotech company , recently identified a new virus that could account for 10 to 20 percent of all hepatitis infections. The new virus, dubbed SEN-V, was first found in the blood of an AIDS patient with unexplained viral hepatitis and has since been identified in other patients with hepatitis and HIV.
For decades, researchers have been puzzled by the high number of hepatitis cases -- about 300,000 annually-that are not caused by any of the known hepatitis viruses, known as hepatitis A through E. They suspect that these cases, known as non-A/E hepatitis, are caused by other viruses but have not been able to identify them. In random screening of blood samples, Primi's team found the SEN virus in 80 percent of patients with non-A/E hepatitis.
More work is planned to determine whether the virus definitely causes hepatitis, and if so, whether it is sexually transmitted. (HIV Plus)