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  • Some data also suggested that CCR could


    Some data also suggested that CCR5Δ32 could influence the progression of HCV-related liver diseases (Goulding et al., 2005; Hellier et al., 2003; Wald et al., 2004). However, after stratifying HCV+ individuals according to clinical/histological criteria, no association of CCR5Δ32 with these HCV-related diseases was observed. Similarly, several studies evaluating distinct populations did not show evidence of a significant influence of CCR5Δ32 on the progression of HCV-related diseases (Goyal et al., 2006; Mangia et al., 2003; Morard et al., 2014; Ruiz-Ferrer et al., 2004; Wasmuth et al., 2004). In conclusion, in individuals from southern Brazil, CCR5Δ32 did not influence the susceptibility to HCV infection, HCV/HIV co-infection, or HCV-related liver disease.
    Acknowledgements and funding
    Introduction Chronic hepatitis C is a major public health problem, with a global prevalence of 2.5%, posing a threat to mortality and morbidity worldwide [1]. It leads to significant liver disease, such as liver cirrhosis and hepatocellular carcinoma, in more than one-third of the patients in its chronic disease course [2]. Recently, with the advent of the curative direct-acting antivirals (DAAs), the prognosis of these patients have been dramatically improved [3]. However, early disease detection remains critical, especially hepatitis C, due to its often irreversible sequelae of liver fibrosis and consequent risk of malignancy. Currently, the diagnosis of Hepatitis C Virus (HCV) is a time-consuming and cost ineffective two-step process [4], [5]. The first step acts as a screening test, whereby anti-HCV 34450 are detected through serological immunoassays. A positive result indicates there is or has been an active infection, and the follow-up diagnostic test is indicated. The second test is the more expensive HCV RNA serology, involving polymerase chain reaction (PCR) technology [2], [4]. Anti-HCV antibodies are created against HCV structural proteins, and exist in the body even after seroconversion. The lack of specificity of the screen is compensated by the molecular test for viral RNA, which measures the degree of viremia through PCR [5], [6]. However, due to the expensiveness and high technicality of PCR machinery, it is impractical for low income countries to routinely administer these tests [5], [6], [7]. Thus, a cheaper alternative is needed for more widespread screening of HCV especially in lower income countries, where HCV is shown to be more prevalent. Since the early 2000s, HCV core antigen (HCV-Ag) quantification enzyme immunoassays (trak-C, Ortho Clinical Diagnostics, Raritan, NJ, USA) have been investigated and heralded as a useful diagnostic tool in addition to current guidelines [8], [9]. However, with the advent of a novel chemiluminescent microparticle immunoassay (ARCHITECT HCV Ag, Abbott, Germany), there has been an improvement in sensitivity with good correlation between HCV-Ag and HCV RNA levels [10]. This has sparked discussion about the possibility of HCV-Ag immunoassays replacing the current gold standard of anti-HCV testing and HCV RNA serology, as a comparable but more cost-effective community screening tool. Hepatitis C virus exists in various genotypes, the most common of which is genotype 1, especially in the Asia-Pacific region [11]. Determining the genotype of an HCV infection has become routine practice since the introduction of DAAs, due to genotype-specific treatment options and genotype-specific government treatment subsidy across many countries [12]. Currently, HCV RNA molecular assay is used to determine HCV genotypes, but there remains inadequate evidence to suggest strong correlation in HCV-Ag in genotyping HCV RNA positive patients [9], [13].
    Patients & method
    Discussion Current guidelines for the screening and diagnosis of HCV denote using a relatively cheap screen with anti-HCV antibody immunoassay, followed by the much costlier molecular test for HCV RNA levels using PCR assay to confirm active HCV infection [6]. Due to the time and cost inefficiency of this two-stage screening/diagnosis process, there has been a push for a one-step HCV 34450 antigen test to diagnose active HCV infection [14], [15]. This is especially the case for lower income countries or regions, where the costly apparatus of a PCR machine is often not practical.