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HLA Class II-DRB1 Alleles with Hepatitis C Virus Infection Outcome in Egypt: A Multicentre Family-based Study
Mahmoud El-Bendary
,
Corresponding author
mmelbendary@gmail.com

Correspondence and reprint request:
, Mustafa Neamatallah, Hatem Elalfy*, Tarek Besheer*, Emily Kamel, Hend Mousa§, Abdel-Hamid Eladl||, Maged El-Setouhy, Abdel-Hady El-Gilany, Ahmed El-Waseef§, Gamal Esmat**
* Tropical Medicine & Hepatology, Mansoura Faculty Of Medicine, Mansoura University, Mansoura,Dakahlyia, Egypt
Medical Biochemistry, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Dakahlyia, Egypt
Public Health & Preventive Medicine, Mansoura Faculty of Medicine, Mansoura University, Mansoura, Dakahlyia, Egypt
§ Biochemistry, Mansoura Faculty of Science, Mansoura University, Mansoura, Dakahlyia, Egypt
|| Internal Medicine Department, Alazhar Faculty of Medicine-Assiut University, Assiut, Egypt
Department of Community and Occupational Medicine, Ain Shams Faculty of Medicine. Ain Shams University, Cairo, Egypt
** Tropical Medicine & Hepatology, Cairo Faculty of Medicine
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="s0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0040">Introduction</span><p id="p0010" class="elsevierStylePara elsevierViewall">Hepatitis C virus &#40;HCV&#41; is a global health problem&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">1</span></a> In 2013 HCV was infecting approximately 2&#37;-3&#37; of the world&#8217;s population&#44; with additional 3-4 millions are infected annually&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> Although acute hepatitis C is asymptomatic&#44; HCV persists in about 70&#37;-85&#37; of cases&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a> The role of nonsexual HCV interfamilial transmission is controversial&#46; The prevalence of anti-HCV antibodies among household contacts of infected patient was found to be 13&#46;7&#37; in Egypt<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">4</span></a> HCV is slowly progressive disease&#44; as cirrhosis will develop in about 20&#37;-30&#37; of patients within 20 years and 1&#37;-4&#37; of them are at high risk of hepatocellular carcinoma &#40;HCC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a> The natural history of HCV infection is determined by a complex interaction between host genetic&#44; immunological and viral factors&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">6</span></a></p><p id="p0015" class="elsevierStylePara elsevierViewall">Although HCV elicits innate immune responses early after infection the virus can overcome the immunity and persist&#46; Viral clearance occurs only in the presence of antiviral CD4&#43; and CD8 &#43; T cell responses&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">7</span></a></p><p id="p0020" class="elsevierStylePara elsevierViewall">The class I and class II human leukocyte antigens &#40;HLA&#41; are ideal candidate genes to study associations between HCV infection and outcomes&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">8</span></a> Specific HLA alleles have been shown to influence the outcome of the HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">5</span></a></p><p id="p0025" class="elsevierStylePara elsevierViewall">Class II is composed of three major genes DR&#44; DQ&#44; and DP&#46; HLA-DR is composed of multiple genes and DRB1 is the most polymorphic and important one which gives variation in immune response&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">8</span></a> A recent study from Egypt reported that the clearance of HCV was associated with DQB1 03&#58;01&#58;01&#58;01 allele while the chronicity of HCV infection was associated with the risk allele&#58; DQB1&#42;02&#58;01&#58;01&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">9</span></a> Several studies reported that HLA-DRB1 alleles may play a critical role in the susceptibility to or clearance from HCV infection and also may determine the response to antiviral drugs&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8&#44;10&#44;11</span></a></p><p id="p0030" class="elsevierStylePara elsevierViewall">The responsibility of the HLA-DRB1 alleles for the susceptibility to HCV infection is highly variable from one population to another&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">11</span></a></p><p id="p0035" class="elsevierStylePara elsevierViewall">We aimed in this study to investigate the role of HLA-DRBlin HCV infection in large family based study community to avoid any concomitant population stratification or type I error&#46;</p></span><span id="s0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0045">Material and Methods</span><span id="s0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0050">Subjects</span><p id="p0040" class="elsevierStylePara elsevierViewall">This multicenter study was carried out in the Molecular Genetic Unit in Endemic Hepatogastroenterology and Infectious Diseases &#40;MGUHID&#41;&#44; Faculty of Medicine&#44; Mansoura University&#46; We investigated Egyptian HCV patients and their families or close household contacts from different Egyptian population representing &#91;Upper Egypt and lower Egypt &#40;including East and West Delta&#41;&#93; Mainly from Dakahlia&#44; Cairo &#38; Assuit governorates between 2011 and 2015&#46; We selected the families on the bases of including at least one positive HCV member &#40;index&#41;&#44; one positive for HCV markers and one family member negative for HCV infection or liver complications and disorders&#46; According to these criteria 162 Egyptian families were recruited in this study with a total of 951 individuals &#40;255 infected participants with chronic hepatitis C &#40;CHC&#41;&#44; 588 controls &#40;a household contact negative to HCV&#41; and108participants who spontaneously cleared the virus &#40;SVC&#41;&#58; i&#46;e with positive Anti-HCV but negative PCR HCV RNA in 2 successive samples at least 6 months apart with no prior history of antiviral therapy&#46; The index cases in the family were selected with inclusion criteria of 1-HCV positive by PCR RNA &#62; 6 months&#44; 2-Adults &#40;above 18 years&#41; of both sexes 3-Any stage of HCV related liver diseases&#44; while exclusion criteria of the index cases were&#58;</p><p id="p0045" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0010"><li class="elsevierStyleListItem" id="u0010"><span class="elsevierStyleLabel">&#8226;</span><p id="p0050" class="elsevierStylePara elsevierViewall">Patients co-infected with HIV or HBV &#40;HBV core antibodies&#41;&#46;</p></li><li class="elsevierStyleListItem" id="u0015"><span class="elsevierStyleLabel">&#8226;</span><p id="p0055" class="elsevierStylePara elsevierViewall">Patient with anti-HCV antibodies positive and no detectable PCR-HCV in the serum&#44; also autoimmune hepatitis&#44; HCC and metabolic liver diseases were excluded&#46;</p></li></ul></p><p id="p0060" class="elsevierStylePara elsevierViewall">Healthy control household contacts were included in this study with inclusion criteria of 1-Age &#62; 18 years of both sex&#44; 2-first and second degree consanguinity to the index case living and sharing usual life activity with index case and having at least 15 years of exposure to the index case&#46; 3-serological evidence of HCV&#44; HBV&#44; HCC&#44; and history of liver diseases were excluded&#46; Each participant was subjected to routine clinical and laboratory investigations by one staff clinician in addition to molecular diagnosis and PCR HCV to confirm HCV infection&#46; All the studied cases were subjected to clinical examinations and routine laboratory investigations &#40;complete blood picture&#44; liver function tests&#41;&#46;</p><p id="p0065" class="elsevierStylePara elsevierViewall">This study was carried out in accordance with the most recent declaration of Helsinki&#44; and each participant signed a written informed consent before participating in the study&#46; The study was reviewed and approved by the Research Ethics Committee &#40;REC&#41; of the Faculty of Medicine&#44; Mansoura University&#44; Egypt&#46;</p></span><span id="s0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0055">Methods</span><p id="p0070" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0015"><li class="elsevierStyleListItem" id="u0020"><span class="elsevierStyleLabel">&#8226;</span><p id="p0075" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">HCV-PCR</span>&#46;</span> Viral RNA was extracted from serum using Qiagen RNA extraction kit &#40;QIA amp&#174; DNA Blood kit &#40;QIAGEN GmbH&#59; Hilden&#8217;s&#44; Germany&#41; according to manufacturer instructions&#46; Extracted HCV RNA samples were quantitatively by real time PCR &#40;Applied Biosystem&#44; Foster City&#44; CA&#44; USA&#44; 7&#44;500 real time PCR system&#41; that determine the viral load of the samples&#46; Sero-negative HCV-Ab were pooled and centrifuged at 15&#44;000 rpm for 60 min&#46; Supernatant was discarded and the pellet was resuspended in 150 <span class="elsevierStyleItalic">j</span>L of supernatant and extracted for viral RNA&#46;</p></li><li class="elsevierStyleListItem" id="u0025"><span class="elsevierStyleLabel">&#8226;</span><p id="p0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">DNA extraction</span>&#46;</span> Genomic DNA was extracted from peripheral blood cells using a DNA extraction kit &#40;QIAmp DNA Mini kit&#59; Qiagen&#44; Hilden&#8217;s&#44; Germany&#41;according to manufacturer instructions&#46; Extracted DNA were assessed by using NanoDropTM &#40;NanoDrop&#8482;2000&#47;2000c spectrophotometer&#44; Thermo Scientific&#44; USA&#41;</p></li><li class="elsevierStyleListItem" id="u0030"><span class="elsevierStyleLabel">&#8226;</span><p id="p0085" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">HLA-DRB1 typing</span>&#46;</span> Low and high resolution typing combine in this complete&#44; two-step system for HLA-DRB1 typing research&#46; The 9 ready-reaction PCR mixes provide high specificity amplification using allele group-specific primers for exon 2 of HLA-DRB1&#46; The PCR products are subsequently sequenced to generate high-resolution allele assignments&#46;</p><p id="p0090" class="elsevierStylePara elsevierViewall">The second exon of HLA-DRB1 gene was typed using sequence based typing &#40;SBT&#41;&#46; For HLA-DRB1exon 2 alleles sequencing&#44; amplification was first done using specific sequence primer pair &#40;Qiagen kit&#41;&#46; The PCR reaction was done using a thermal cycler &#40;Applied Biosystems&#44; 2720&#41;&#46; A cycle sequence was performed for the purified PCR product in the forward direction by the forward primer using Big Dye TM terminator Cycle sequencing kits &#40;versions 3&#46;0&#41; according to manufacturer&#8217;s protocol&#46; Sequenced products were then separated by capillary electrophoresis using an Applied Biosystems 310 Genetic Analyzer&#46; Sequences were analyzed with dedicated software&#46;</p></li><li class="elsevierStyleListItem" id="u0035"><span class="elsevierStyleLabel">&#8226;</span><p id="p0095" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic"><span class="elsevierStyleBold">HLA genotyping analysis</span>&#46;</span> This consensus sequences were compared against the appropriate library of HLA alleles &#40;www&#46;ebi&#46;ac&#46;uk&#47;ipd&#47;imgt&#47;hla&#47;blast&#46;html&#41; and &#40;http&#58;&#47;&#47;blast&#46;ncbi&#46;nlm&#46;nih&#46;gov&#41;&#41; to obtain the results of specific allele sequence&#46;</p></li></ul></p></span><span id="s0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0060">Statistical analysis</span><p id="p0100" class="elsevierStylePara elsevierViewall">Data were computed and statistically analyzed using SPSS software program&#46; &#40;IBM Corp&#46; Released 2012&#46; IBM SPSS Statistics for Windows&#44; Version 21&#46;0&#46; Armonk&#44; NY&#58; IBM Corp&#41;&#46; For comparison of qualitative variables &#40;presented as frequencies and percentages&#41; &#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> of Fisher Exact test were used&#46; Hardy Weinberg equilibrium &#40;HWE&#41; was assessed in each group separately using &#37;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> tests&#46; The allele carriage is defined as the number of individuals carrying at least one copy of a specific allele&#46; Allelic frequencies are defined as the number of occurrences of the test allele divided by the total number of alleles in the group&#46; Odds ratio at 95&#37; confidence interval &#40;CI&#41; of specific allele carriage was calculated compared with the non-carriage of target allele using Med Calc software&#40;Med Calc statistical software version 16&#46;4&#46;3&#46; Med Calc &#40;software bvba&#44; Ostend&#44;Belgium&#59; https&#58;&#47;&#47;www&#46;medcalc&#46;org&#59; 2016&#41;&#46; The difference was considered significant if P &#60; 0&#46;05&#46; OR and confidence interval was calculated using two by two contingency table by comparing the allele carriage of at least one copy of this allele in different groups&#46; If OR and 95 &#37;CI is greater than 1&#46; It mean this allele is a risk one&#46; The allele is considered as protective allele if OR and 95&#37; CI is less than one&#46; The p value statistic of OR was adjusted using Bonferroni formula &#40;P<span class="elsevierStyleInf">C</span> corrected&#41; The Bonferroni corrected-p value is an adjustment made to P values when several dependent or independent statistical tests are being performed simultaneously on a single data set&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">12</span></a></p></span></span><span id="s0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0065">Results</span><p id="p0105" class="elsevierStylePara elsevierViewall">The laboratory charateristics of the studied groups are shown in <a class="elsevierStyleCrossRef" href="#t0010">table 1</a>&#46;</p><elsevierMultimedia ident="t0010"></elsevierMultimedia><span id="s0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0070">Descriptive genetic analysis data for HLA-DRB1 alleles</span><p id="p0110" class="elsevierStylePara elsevierViewall">Genetic analysis data for HLA-DQB1 alleles in <a class="elsevierStyleCrossRef" href="#t0015">table 2</a> showed that the Matching Probability&#44; Power of Discrimination&#44; PIC &#40;polymorphic information content&#41;&#44; Homozygotes&#44; Heterozygotes rates showed no significant differences between&#44; chronic HCV&#40;CHC&#41;&#44; control and SVC groups&#46; The analysis showed that the PIC for CHC&#44; control subjects and SVC group ranged from &#40;0&#46;70 to 0&#46;91&#41; and heterozygosity ranged from &#40;73&#46;14 to 90&#46;58&#41; which indicates that this locus is highly polymorphic enough to do statistical analysis in Egyptians&#46;</p><elsevierMultimedia ident="t0015"></elsevierMultimedia></span><span id="s0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0075">Allele frequency and allele carriage of HLA-DRB1 alleles in different groups</span><p id="p0115" class="elsevierStylePara elsevierViewall">Analysis of the frequency of HLA-DRB1 alleles in CHC&#44; control&#44; and SVC groups revealed that DRB1&#42;13&#58;01&#58;01 &#40;26&#46;07&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>&#41; is the most frequent allele in positive cases&#44; followed by DRB1&#42; 13&#58;02&#58;01 and DRB1&#42;03&#58;01&#58;01 &#40;25&#46;29&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#f0010">Figure 1</a>&#41;&#46; In control&#44; DRB1&#42;11&#58;01&#58;01 is the most frequent allele &#40;14&#46;88&#37;&#41; followed by DRB1&#42;3&#58;01&#58;01 &#40;13&#46;1&#37;&#41; and DRB1&#42;07&#58;01&#58;01 &#40;10&#46;88&#37;&#41;&#46; In SVC group&#44; DRB1&#42;11&#58;01&#58;01 &#40;20&#46;37&#37;&#41; is the most frequent allele &#40;<a class="elsevierStyleCrossRef" href="#f0015">Figure 2</a>&#41;&#44; followed by DRB1&#42;1&#58;01&#58;01 &#40;13&#46;89&#37;&#41; and DRB1&#42;03&#58;01&#58;01 &#40;12&#46;04&#37;&#41; wh ile other alleles showed less equal frequencies &#40;<a class="elsevierStyleCrossRef" href="#t0020">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="f0010"></elsevierMultimedia><elsevierMultimedia ident="f0015"></elsevierMultimedia><elsevierMultimedia ident="t0020"></elsevierMultimedia><p id="p0120" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#t0025">Table 4</a>&#44; comparing the distribution of HLA-DRB1 alleles between CHC&#44; control and SVC groups revealed that&#58; The carriage of allele 3&#58;01&#58;01 was significant in C HC group wh en compared to that of control and SVC groups &#40;OR &#61; 5&#46;1289&#44; 95&#37; CI&#58; 3&#46;8570 to 6&#46;8225&#44; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;001&#59; and OR &#61; 5&#46;9847&#44; 95&#37; CI&#58; 3&#46;6217 to 9&#46;8896&#44; <span class="elsevierStyleItalic">P &#60;</span> 0&#46;000&#44; 1 <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006&#41; respectively&#46; The carriage of allele 13&#58;01&#58;01 was significantly higher in CHC group when compared to control and SVC groups&#46; After Bonferroni correction the result remain significant &#40;OR &#61; 4&#46;6860&#44; CI&#58; 3&#46;3702 to 6&#46;5156&#44; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;0001 <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006 and OR &#61; 6&#46;5987&#44; CI&#58; 3&#46;5159 to 12&#46;3846&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0001&#44; <span class="elsevierStyleItalic">Pc</span> &#61; 0&#46;0006&#41; respectively&#46; On the other hand&#44; DRB1 &#42;040501 and DRB1&#42; 110101 alleles were more frequent in both control and SVC groups more than in CHC patients &#40;for DRB1 &#42;04051 OR &#61; 0&#46;4052 CI&#58; 0&#46;2543 to 0&#46;6456&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0001&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006 and OR &#61; 0&#46;4061&#44; CI&#58; 0&#46;2165 to 0&#46;7620 <span class="elsevierStyleItalic">P</span> &#61; 0&#46;005&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;03 respectively&#46; For DRB1&#42;110101 OR &#61; 0&#46;2169&#44; CI&#58; 0&#46;1345 to 0&#46;3498&#44; <span class="elsevierStyleItalic">p</span> &#61; 0&#46;0001&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006 and OR &#61; 0&#46;1739&#44; CI&#58; 0&#46;0965 to 0&#46;3135&#44; <span class="elsevierStyleItalic">P</span> &#60; 0&#46;0001 <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0001 respectively&#41;&#46; While DRB1&#42;040101 was statistically significant in SVC group when compared to both CHC &#38; control groups &#40;OR &#61; 0&#46;0916&#44; CI&#58; 0&#46;0299 to 0&#46;2812&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0001&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006 and OR &#61; 0&#46;2130&#44; CI&#58; 0&#46;1072 to 0&#46;4232&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;0001&#44; <span class="elsevierStyleItalic">Pc</span> &#61; 0&#46;0006&#41;&#46; The carriage of alleles 7 family &#40;7&#58;01&#58;01&#41; was found to be significantly higher in both control and SVC groups when both were compared to CHC group even after Bonferroni correction the results remain significant &#40;OR &#61; 0&#46;1833&#44; CI&#58; 0&#46;0970 to 0&#46;3464 <span class="elsevierStyleItalic">P</span> &#60; 0&#46;0001&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;0006 and OR &#61; 0&#46;2592&#44; CI&#58; 0&#46;1160 to 0&#46;5794&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;001&#44; <span class="elsevierStyleItalic">P<span class="elsevierStyleInf">c</span></span> &#61; 0&#46;006 respectively&#41;&#46; Also no significant association was found when a comparison was made between control and SVC group &#40;OR &#61; 1&#46;4744&#44; CI&#58; 0&#46;8359 to 2&#46;6006&#44; <span class="elsevierStyleItalic">P</span> &#61; 0&#46;1883&#41;&#46;</p><elsevierMultimedia ident="t0025"></elsevierMultimedia></span></span><span id="s0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0080">Discussion</span><p id="p0125" class="elsevierStylePara elsevierViewall">HCV is a major health problem in Egypt affecting more than 10&#37; of the population&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">2</span></a> Interplay between host and environmental factors are major determinants of HCV infection outcome&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">13</span></a> A number of baseline factors were reported as independent predictors for HCV infection<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">14&#44;15</span></a> including&#44; low viral load&#44; HCV genotype&#44; absence of co infection as well as the host immunogenetic factors including human leukocyte antigen &#40;HLA-DRB1&#41; alleles&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">7&#44;16</span></a></p><p id="p0130" class="elsevierStylePara elsevierViewall">Polymorphism in the peptide binding regions of HLA-DR molecules determines antigenic specificities and strength of immune response to a given pathogen&#46; It is well known that HLA-DRB1 alleles are crucial factors regulating cellular and humoral immune response through producing HLA-DR molecules participating in presentation of viral antigens on the surface of antigen presenting cells to CD4 &#43; T cells&#46;<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">17&#44;18</span></a> Genes of DR may determine HCV infection outcome and are prominent immunogenic factors influencing response to interferon treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">19</span></a> The presence of specific HLA-DRB1 alleles may affect the HCV infection but associations vary among populations and results are controversial&#46;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">3&#44;20</span></a></p><p id="p0135" class="elsevierStylePara elsevierViewall">To the best of our knowledge&#44; this study is the first multicentre one to test the association between HLA-DRB1 alleles and HCV infection outcome among the Egyptian families&#46;</p><p id="p0140" class="elsevierStylePara elsevierViewall">Studies of the relations between human leukocyte antigens and HCV infection showed inconsistent results&#46; This inconstancy may be due to improper diagnosis and classification of the disease&#44; population stratification&#44; ethnic variation&#44; or inadequate sample sizes&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">11</span></a> Another cause may be due to comparing the studied groups either &#40;persistence of infection group or virus clearance group&#41; with healthy control only&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> The problem of using healthy control subject is that about 80&#37; of these subjects when exposed for the first time to HCV will develop chronicity while the rest showed spontaneous viral clearance &#40;SVC&#41;&#46;To overcome this inconstancy&#44; subjects with Spontaneous viral clearance &#40;SVC&#41; should be compared to subjects with persistence of infection &#40;CHC&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a></p><p id="p0145" class="elsevierStylePara elsevierViewall">Comparing the distribution of HLA-DRB1 alleles between CHC and other 2 groups revealed that the carriage of alleles 3&#58;01&#58;01 and 13&#58;01&#58;01 were significantly higher in CHC compared to control and SVC groups &#40;i&#46;e&#46; These alleles associated with persistence of HCV infection&#41;&#46;</p><p id="p0150" class="elsevierStylePara elsevierViewall">On the other hand&#44; DRB1&#42;04&#58;01&#58;01&#44; DRB1&#42;04&#58;05&#58;01&#44; DRB1&#42;7&#58;01&#58;01 and DRB1&#42;11&#58;01&#58;01 alleles were more frequent in SVC group when compared to CHC patients &#40;i&#46;e&#46; These alleles associated with protection against HCV infection&#41;&#46;</p><p id="p0155" class="elsevierStylePara elsevierViewall">These results are consistent with previous results from different ethnic groups&#46; In Caucasian American and in large multiracial cohort of U&#46;S&#46; women viral persistence was associated with DRB1&#42;0301&#46;<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">11&#44;22</span></a></p><p id="p0160" class="elsevierStylePara elsevierViewall">Several studies conducted in Italian neonates&#44; Spanish Irish&#44; Northern European Caucasoid &#40;NEC&#41;&#44; France&#44; Thailand and Indian populations showed that DRB1&#42;03 was associated with persistence of HCV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">8&#44;19&#44;23-27</span></a> On the other hand HLA-DRB1&#42;11 seems to be protective against the development of severe forms of HCV infection in Spanish&#44; Italian neonates&#44; France and UK&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">19&#44;28-30</span></a> Whereas in Japanese DRB1&#42;1101 was more frequently found in carriers with persistently normal ALT values than in patients with CLD&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a></p><p id="p0165" class="elsevierStylePara elsevierViewall">A German study of North Europeans found that DRB1&#42;13 was associated with susceptibility to HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">32</span></a> However another study revealed that HLA-DRB1&#42;11 allele was associated with a reduced risk for the development of HCV induced end stage liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">33</span></a></p><p id="p0170" class="elsevierStylePara elsevierViewall">A meta-analysis carried on by Yee&#44; <span class="elsevierStyleItalic">et al&#46;</span> 2004 involving Caucasian population only from the period of 1997-2002 concluded that DRB1&#42;11 was associated with protection against HCV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">13&#44;26&#44;27&#44;34-37</span></a> But these studies are generally smaller in size&#44; less conclusive and performed with low resolution techniques&#46;</p><p id="p0175" class="elsevierStylePara elsevierViewall">In China it was found that DRB1&#42;1101 was a protective allele and subjects with this allele are at a lower risk of developing chronic HCV&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">38</span></a></p><p id="p0180" class="elsevierStylePara elsevierViewall">In Brazilian population it was confirmed that there were higher frequencies of HLA-DRB1&#42;13 in patients compared with controls while DRB1&#42;11was associated with protection from chronic HCV infection&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">39&#44;40</span></a> Also in Pakistan and Iran DRB1&#42;11 was associated with viral clearance&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">41&#44;42</span></a> While in Iraq&#44; it was found that the presence of DRB1&#42;11 was significantly associated with increased risk for HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0220"><span class="elsevierStyleSup">43</span></a></p><p id="p0185" class="elsevierStylePara elsevierViewall">Reports from Egypt addressed that HLA-DRB1&#42;03 individually or in combination with HLA-DRB1&#42;04 act as a protective alleles against HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">44</span></a> While In Egyptian HCV infected children it was reported that the most frequent alleles demonstrated among patients were DRB1 &#42;03&#44; DRB1 &#42;04 and DRB1 &#42;13 while DRB1&#42;15 was significantly reduced among patients when compared with the control group&#46;<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">45</span></a> Shaker&#44; <span class="elsevierStyleItalic">et al&#46;</span> 2013 found that DRB1&#42;04 and DRB1&#42;11 were significantly more frequent in non responders than in responders&#46; In contrast&#44; DRB1&#42;13 and DRB1&#42;15 alleles were significantly more frequent in responders than in non responders&#46; However this study compared the patients with the healthy control group not to the SVC group making these results inconsistent&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">10</span></a></p><p id="p0190" class="elsevierStylePara elsevierViewall">There are other studies found that other HLA-DRB1 alleles were associated with the susceptibility to HCV infection&#46; The frequency of DRB1&#42;0405 was higher in HCV-infected patients than in uninfected subjects in Japan&#44;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">31</span></a> whereas DRB1&#42;1302 was more frequently found in carriers with persistently normal ALT values than in patients with CLD&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">3</span></a></p><p id="p0195" class="elsevierStylePara elsevierViewall">Different studies carried on populations with different ethnic origin showed that the virus clearance was associated with the DRB1&#42;1 and DRB1&#42;13 in Caucasians &#40;European and Americans&#41; and with DRB1&#42;12 in Non-Caucasian Americans&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">46</span></a> While the susceptibility to infection was connected to DRB1&#42;3 and DRB1&#42;7 in Caucasians &#40;European and Americans&#41; and to DRB1&#42;12 in Caucasians Americans only&#46; In a Midwestern American cohort reported the associations of DRB1&#42;12 with HCV infection&#46;<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">21</span></a> Furthermore in Taiwan population it was suggested that DRB1&#42;12 was significantly associated with the risk of HCC&#46;<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">47</span></a> In contradiction to these results&#44; it was found that interaction between the KIR receptor gene 2DL3 with HLA-DRB1&#42;1201 was associated with SVC&#46;<a class="elsevierStyleCrossRef" href="#bib0245"><span class="elsevierStyleSup">48</span></a></p><p id="p0200" class="elsevierStylePara elsevierViewall">Several reports from different ethnic origin in the world reported that DRB1&#42;07 allele was linked to viral persistence of HCV infection&#46; &#40;in British&#44; Polish&#44;Italian&#44; Brazilian&#44; Mid western Americans and Pakistanian populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">19&#44;21&#44;27&#44;39&#44;41&#44;49</span></a> On the other hand in Iranian and Thailand HCV infected patient DRB1&#42;0701 allele was found to be significantly presented in patients with HCV clearance&#46;<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">24&#44;42</span></a></p><p id="p0205" class="elsevierStylePara elsevierViewall">DRB1&#42;01 is associated with viral clearance in a large multiracial cohort of U&#46;S&#46; women with a high prevalence of HCV and HIV&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">22</span></a> Same results were reported in white subjects and in Swiss Cohor&#44; but another investigators reported that DRB1&#42;1001 was associated with disease&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">27</span></a></p><p id="p0210" class="elsevierStylePara elsevierViewall">Conflicting reports as regard DRB1&#42;08 were recorded&#44; whereas DRB1&#42;0803 in Korean patients was associated with chronic HCV carriers&#44;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">50</span></a> in Tunisian patients it was associated with clearance of circulating HCV&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">51</span></a></p><p id="p0215" class="elsevierStylePara elsevierViewall">The frequency of DRB1&#42;15 was associated with SVC but in Tunisian patients it appears to predispose to progression of liver disease&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">51</span></a></p><p id="p0220" class="elsevierStylePara elsevierViewall">In conclusion&#44; the present study suggested that certain HLA-DRB1 alleles namely DRB1&#42;03&#58;01&#58;01 and DRB1&#42; 13&#58;01&#58;01 may act as a risk alleles for HCV persistence while DRB1&#42;04&#58;01&#58;01&#44; DRB1&#42;04&#58;05&#58;01&#44; DRB1&#42;7&#58;01&#58;01 and DRB1&#42;11&#58;01&#58;01 alleles were associated with HCV clearance in the Egyptian families&#46; This is important for disease management and deciding which person would most likely susceptible to HCV infection and which would not&#46; It is strongly recommended that further investigations are needed to study more associations of these factors which may affect HCV susceptibility in the Egyptian population which may help towards eradication of HCV&#46;</p></span><span id="s0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0085">Acknowledgement</span><p id="p0225" class="elsevierStylePara elsevierViewall">We would like to thank Medical Biochemistry department &#38;xMedical Expreimental Research Centre &#40;MERC&#41;-Mansoura Faculty of Medicine&#44; Mansoura University for their kind help &#38; support to complete routine laboratory work&#46;</p></span><span id="s0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0090">Abbreviations</span><p id="p0230" class="elsevierStylePara elsevierViewall"><ul class="elsevierStyleList" id="l0020"><li class="elsevierStyleListItem" id="u0040"><span class="elsevierStyleLabel">&#8226;</span><p id="p0235" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Ab</span>&#58; antibody&#46;</p></li><li class="elsevierStyleListItem" id="u0045"><span class="elsevierStyleLabel">&#8226;</span><p id="p0240" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">AFP</span>&#46; alpha feto protein&#46;</p></li><li class="elsevierStyleListItem" id="u0050"><span class="elsevierStyleLabel">&#8226;</span><p id="p0245" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CHC</span>&#58; chronic hepatitis C&#46;</p></li><li class="elsevierStyleListItem" id="u0055"><span class="elsevierStyleLabel">&#8226;</span><p id="p0250" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CI</span>&#58; confidence interval&#46;</p></li><li class="elsevierStyleListItem" id="u0060"><span class="elsevierStyleLabel">&#8226;</span><p id="p0255" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">CV</span>&#58; chronic viraemia&#46;</p></li><li class="elsevierStyleListItem" id="u0065"><span class="elsevierStyleLabel">&#8226;</span><p id="p0260" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">ELISA</span>&#58; enzyme linked immune sorbont assay&#46;</p></li><li class="elsevierStyleListItem" id="u0070"><span class="elsevierStyleLabel">&#8226;</span><p id="p0265" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HBV</span>&#58; hepatitis B virus&#46;</p></li><li class="elsevierStyleListItem" id="u0075"><span class="elsevierStyleLabel">&#8226;</span><p id="p0270" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCC</span>&#58; hepatocellular carcinoma&#46;</p></li><li class="elsevierStyleListItem" id="u0080"><span class="elsevierStyleLabel">&#8226;</span><p id="p0275" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HCV</span>&#58; hepatitis C virus&#46;</p></li><li class="elsevierStyleListItem" id="u0085"><span class="elsevierStyleLabel">&#8226;</span><p id="p0280" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HIV</span>&#58; human immundefeciency virus&#46;</p></li><li class="elsevierStyleListItem" id="u0090"><span class="elsevierStyleLabel">&#8226;</span><p id="p0285" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HLA</span>&#58; human leukocyte antigen&#46;</p></li><li class="elsevierStyleListItem" id="u0095"><span class="elsevierStyleLabel">&#8226;</span><p id="p0290" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">HWE</span>&#58; hardy weinberg equilibrium&#46;</p></li><li class="elsevierStyleListItem" id="u0100"><span class="elsevierStyleLabel">&#8226;</span><p id="p0295" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">LC</span>&#58; liver cirrhosis&#46;</p></li><li class="elsevierStyleListItem" id="u0105"><span class="elsevierStyleLabel">&#8226;</span><p id="p0300" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">MHC</span>&#58; major histocompatibility complex&#46;</p></li><li class="elsevierStyleListItem" id="u0110"><span class="elsevierStyleLabel">&#8226;</span><p id="p0305" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">OR</span>&#58; odd</p></li><li class="elsevierStyleListItem" id="u0115"><span class="elsevierStyleLabel">&#8226;</span><p id="p0310" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">PC</span>&#58; bonferroni correction&#46;</p></li><li class="elsevierStyleListItem" id="u0120"><span class="elsevierStyleLabel">&#8226;</span><p id="p0315" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SBT</span>&#58; sequence-based typing&#46;</p></li><li class="elsevierStyleListItem" id="u0125"><span class="elsevierStyleLabel">&#8226;</span><p id="p0320" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SCV</span>&#58; spontaneously cleared the virus&#46;</p></li><li class="elsevierStyleListItem" id="u0130"><span class="elsevierStyleLabel">&#8226;</span><p id="p0325" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">SSP-PCR</span>&#58; sequence specific primer-polymerase chain reaction&#46;</p></li><li class="elsevierStyleListItem" id="u0135"><span class="elsevierStyleLabel">&#8226;</span><p id="p0330" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">UV</span>&#58; ultra violet&#46;</p></li><li class="elsevierStyleListItem" id="u0140"><span class="elsevierStyleLabel">&#8226;</span><p id="p0335" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">VC</span>&#58; viral clearance&#46;</p></li></ul></p></span><span id="s0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0095">Conflict of Interest</span><p id="p0340" class="elsevierStylePara elsevierViewall">The authors declares that there is no conflict of interest regarding the publication of this article&#46;</p></span><span id="s0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="st0100">Financial Support</span><p id="p0345" class="elsevierStylePara elsevierViewall">This research was funded by Science &#38; Technology Development Foundation &#40;STDF&#41;&#44; Project NO&#46;1784 &#40;TC&#47;2&#47;Health&#47;2009&#47;hep-1&#46;3&#41;&#46;</p></span></span>"
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        2 => array:2 [
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          "titulo" => "Introduction"
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          "titulo" => "Material and Methods"
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          "titulo" => "Results"
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            0 => array:2 [
              "identificador" => "s0040"
              "titulo" => "Descriptive genetic analysis data for HLA-DRB1 alleles"
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            1 => array:2 [
              "identificador" => "s0045"
              "titulo" => "Allele frequency and allele carriage of HLA-DRB1 alleles in different groups"
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          "titulo" => "Discussion"
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          "identificador" => "s0055"
          "titulo" => "Acknowledgement"
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          "identificador" => "s0060"
          "titulo" => "Abbreviations"
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          "titulo" => "Conflict of Interest"
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          "titulo" => "References"
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    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-06-06"
    "fechaAceptado" => "2017-12-11"
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      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Key words"
          "identificador" => "xpalclavsec1138851"
          "palabras" => array:4 [
            0 => "HCV susceptibility"
            1 => "HLA-DRB1 polymorphism"
            2 => "virus clearance"
            3 => "intrafamilial"
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    "resumen" => array:1 [
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        "titulo" => "Abstract"
        "resumen" => "<span id="abs0010" class="elsevierStyleSection elsevierViewall"><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introduction and aim</span>&#46; Hepatitis C virus &#40;HCV&#41; infection is a global medical problem&#46; HLA -DRB1 alleles have an important role in immune response against HCV&#46; The aim of this study is to clarify the contribution of HLA -DRB1 alleles in HCV susceptibility in a multicentre family-based study&#46;</p><p id="sp0045" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Material and methods</span>&#46; A total of 162 Egyptian families were recruited in this study with a total of 951 individuals &#40;255 with chronic hepatitis C &#40;CHC&#41;&#44; 588 persons in the control group&#40;-ve household contact to HCV&#41; and 108 persons who spontaneously cleared the virus &#40;SVC&#41;&#46; All subjects were genotyped for HLA -DRB1 alleles by SSP-PCR and sequence based typing &#40;SBT&#41; methods&#46;</p><p id="sp0050" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Results</span>&#46; The carriage of alleles 3&#58;01&#58;01 and 13&#58;01&#58;01 were highly significant in CHC when compared to that of control and SVC groups &#91;OR of 3 family &#61; 5&#46;1289&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#40;Bonferroni correction &#41; &#61; 0&#46;0002 and 5&#46;9847&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0001 and OR of 13 family &#61; 4&#46;6860&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0002 and OR &#61; 6&#46;5987&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0001 respectively&#93;&#46; While DRB1&#42;040501&#44; DRB1&#42;040101&#44; DRB1&#42;7&#58;01&#58;01 and DRB1&#42;110101 alleles were more frequent in SVC group than CHC patients &#40;OR &#61; 0&#46;4052&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;03&#44; OR&#58; OR &#61; 0&#46;0916&#44;<span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0006&#44; OR &#61; 0&#46;1833&#44;<span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0006 and OR &#61; 0&#46;4061&#44; <span class="elsevierStyleItalic"><span class="elsevierStyleBold">P<span class="elsevierStyleInf">C</span></span></span> &#61; 0&#46;0001 respectively&#41;&#46;</p><p id="sp0055" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Conclusions</span>&#46; It was concluded that among the Egyptian families&#44; HLA-DRB1&#42;030101&#44; and DRB1&#42;130101 alleles associated with the risk of progression to CHC infection&#44; while DRB1&#42;040101&#44; DRB1&#42;040501&#44; DRB1&#42;7&#58;01&#58;01and DRB1&#42;110101 act as protective alleles against HCV infection&#46;</p></span>"
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          "en" => "<p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">Cycle sequencing analysis of exon 2 of HLA-DRB1&#42;&#58;03&#58;01&#58;01 &#38; HLA-DRB1&#42;&#58;13&#58;01&#58;01alleles&#46;</p>"
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          "en" => "<p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">Cycle sequencing analysis of exon 2 of HLA-DRB1&#42;11&#58;01&#58;01 allele</p>"
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        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
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        "fuente" => "<span class="elsevierStyleItalic">S&#46; bilirubin &#40;N&#58; &#60; 1&#46;1 mg&#47;dL&#41;&#46; S&#46; albumin &#40;N 3&#46;9-5&#46;1 g&#47;dL&#41;&#46; SGOT &#40;aspartate aminotransferase&#41; &#40;N &#60; 40 IU&#47;L&#41;&#46; &#40;SGPT&#41; alanine aminotransferase &#40;N &#60; 45 &#33;U&#47;L&#41;&#46; ALP&#58; alkaline phosphatase &#40;N&#58; 37-116 U&#47;L&#41;&#46; Alpha fetoprotein &#40;AFP&#41; &#40;N &#60; 10 ng&#47;mL&#41;&#58; antinuclear antibodies &#40;ANA&#41; &#40;N &#60; 1&#46;1 U&#41;&#46; S&#46; creatinine &#40;N &#60; 1&#46;4 mg&#47;dL&#41;&#46; S&#46; cholesterol &#40;N &#60; 200 mg&#47;dL&#41;&#46; CHC&#58; chronic hepatitis C&#46; SVC&#58; spontaneous virus clearance&#46;</span>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Positive group &#40;CHC&#41; &#40;255&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Control group &#40;588&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Spontaneous clearance&#40;SVC&#41; &#40;108&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="4" align="left" valign="top">Sex</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">185 &#40;72&#46;22&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">277 &#40;47&#46;11&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;65&#46;74&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;27&#46;78&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">311 &#40;52&#46;89&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">37 &#40;34&#46;26&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Parameters&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Mean &#40;&#177;SD&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">41&#46;5 &#40;13&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&#46;7 &#40;22&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43 &#40;10&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">S&#46; bilirubin &#40;mg&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;6 &#40;0&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">S&#46; albumin &#40;gm&#47;dL&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ALP U&#47;L&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">ANA &#40;U&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">166 &#40;21&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                  \t\t\t\t">Homozygotes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Heterozygotes&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">84&#46;35&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Hardy-Weinberg&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">X<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;75212&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&#46;16124&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">P</span>&nbsp;\t\t\t\t\t\t\n
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                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2092133.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">Descriptive genetic analysis data of HLA-DRB1 alleles in different groups</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "t0020"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "<span class="elsevierStyleItalic">In each cell&#59; the upper numbers represent the carriage number of homozygous&#47; carriage number of heterozygous&#59; The lower number represents the allele frequency&#46; Total positive &#61; index cases &#43; positive relative&#46;</span>"
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Alleles&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Total &#40;951&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1 0&#46;53&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;1 0&#46;19&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;11 0&#46;93&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#47;0 0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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              ]
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        "descripcion" => array:1 [
          "en" => "<p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">Allele carriages and allele frequencies of DRB1 Loci in different study groups&#46;</p>"
        ]
      ]
      5 => array:8 [
        "identificador" => "t0025"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "fuente" => "OR&#58; odds Rrtio&#46; CI&#58; confidence interval&#46; vs&#46; versus&#46; Pc&#58; P&#40;<span class="elsevierStyleInf">corrected</span> or Bonferroni correction&#46; Bonferroni correction was applied when P &#60; 0&#46;05&#44; Risk allele If OR and CI &#62; 1&#46;0 and Pc &#60; 0&#46;05&#46; Protective allele If OR and Ci &#60; 1&#46;0 and Pc &#60; 0&#46;05&#46;"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Allele&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&#40;CHC&#41; vs&#46; negative control</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Positive&#40;CHC&#41; vs&#46; spontaneous &#40;SVC&#41;</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Spontaneous clearance&#40;SVC&#41; vs&#46; negative control</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">OR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">P&#40;Pc&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">OR &#40;95 &#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">03&#58;01&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;1298 &#40;3&#46;8570 to 6&#46;8225&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&#46;9847 &#40;3&#46;6217 to 9&#46;8896&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;1667 &#40;0&#46;7143 to 1&#46;9054&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;5380 NA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">04&#58;01&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1257 NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0916 &#40;0&#46;0299 to 0&#46;2812&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2130 &#40;0&#46;1072 to 0&#46;4232&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">04&#58;05&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4052 &#40;0&#46;2543 to 0&#46;6456&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001 0&#46;0006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;4061 &#40;0&#46;2165 to 0&#46;7620&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0050 0&#46;0300&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;0023 &#40;0&#46;6022 to 1&#46;6682&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;9929 NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">07&#58;01&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1833 &#40;0&#46;0970 to 0&#46;3464&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2592 &#40;0&#46;1160 to 0&#46;5794&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0010 &#40;0&#46;0060&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4744 &#40;0&#46;8359 to 2&#46;6006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1883 NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&#58;01&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2169 &#40;0&#46;1345 to 0&#46;3498&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 0&#46;0006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;1739 &#40;0&#46;0965 to 0&#46;3135&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;8019 &#40;0&#46;5166 to 1&#46;2445&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;3248 NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#58;01&#58;01&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;6860 &#40;3&#46;3702 to 6&#46;5156&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&#46;5987 &#40;3&#46;5159 to 12&#46;3846&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 0&#46;0001 &#40;0&#46;0006&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;4082 &#40;0&#46;7577 to 2&#46;6172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;2791 NA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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                0 => "xTab2092132.png"
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        "descripcion" => array:1 [
          "en" => "<p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">Odds ratio of common allele of DRB1 Locus in different study groups&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bs0010"
          "bibliografiaReferencia" => array:51 [
            0 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "1&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Global Distribution and Prevalence of Hepatitis C Virus Genotypes&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:7 [
                            0 => "Messina J&#46;P&#46;"
                            1 => "Humphreys I&#46;"
                            2 => "Flaxman A&#46;"
                            3 => "Brown A&#46;"
                            4 => "Cooke G&#46;S&#46;"
                            5 => "Pybus O&#46;G&#46;"
                            6 => "Barnes E&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hepatology &#40;Baltimore&#44; Md&#41;"
                        "fecha" => "2015"
                        "volumen" => "61"
                        "paginaInicial" => "77"
                        "paginaFinal" => "87"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "2&#46;"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Burden of pediatric hepatitis C&#46;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "El-Shabrawi M&#46;H&#46;"
                            1 => "Kamal N&#46;M&#46;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.3748/wjg.v19.i44.7880"
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2013"
                        "volumen" => "19"
                        "paginaInicial" => "7880"
                        "paginaFinal" => "7888"
                        "link" => array:1 [
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos