Alta prevalencia e incidencia de lesiones precursoras de cáncer anal asociada a la infección por VPH en mujeres VIH positivas en la era tardía del TAR

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El CC es una neoplasia definitoria de sida&#44; y era la m&#225;s frecuente en mujeres seropositivas antes de la introducci&#243;n del tratamiento antirretroviral de alta eficacia &#40;TAR&#41;&#59; tras el TAR y la instauraci&#243;n de programas de cribado de CC se produjo una importante reducci&#243;n en su incidencia<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">4</span></a>&#46; En cuanto al efecto que el TAR podr&#237;a ocasionar sobre la aparici&#243;n de CA&#44; ha sido considerado controvertido&#59; en trabajos realizados durante el per&#237;odo previo a su administraci&#243;n o cercanos a su introducci&#243;n se encontr&#243; un incremento en la incidencia&#44; posiblemente en relaci&#243;n con el aumento de la supervivencia de los pacientes<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">5-8</span></a>&#46; Sin embargo&#44; en estudios m&#225;s recientes realizados en HSH seropositivos se ha encontrado que el tratamiento antirretroviral podr&#237;a ejercer cierto efecto protector frente a la presencia de lesi&#243;n intraepitelial de alto grado o lesi&#243;n precursora &#40;HSIL&#41; y CA<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9-11</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Por el momento&#44; entre las diferentes sociedades cient&#237;ficas de VIH no existe consenso ni homogeneidad en las recomendaciones sobre el cribado de HSIL y CA&#44; no solo en relaci&#243;n al procedimiento y t&#233;cnica&#44; sino en lo referente al tipo de paciente en el que se debe implementar<a class="elsevierStyleCrossRefs" href="#bib0230"><span class="elsevierStyleSup">12&#44;13</span></a>&#46; En Espa&#241;a&#44; GESIDA&#44; en su Documento de consenso sobre diagn&#243;stico y tratamiento de las infecciones de transmisi&#243;n sexual en adultos&#44; ni&#241;os y adolescentes de 2017&#44; contempla la realizaci&#243;n de citolog&#237;a anal en pacientes VIH positivos con condilomas&#44; HSH y mujeres con displasia cervical<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">12</span></a>&#46; La citolog&#237;a es la t&#233;cnica m&#225;s empleada en el cribado de HSIL y CA&#44; pero esta herramienta tiene una sensibilidad variable y limitada&#44; lo que se traduce en un porcentaje no despreciable de pacientes infradiagnosticados con dichas lesiones&#44; como se demuestra en algunos estudios<a class="elsevierStyleCrossRefs" href="#bib0240"><span class="elsevierStyleSup">14-16</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Con este trabajo queremos evaluar la prevalencia e incidencia de HSIL y CA en nuestra cohorte de mujeres seropositivas &#40;MVIH&#43;&#41;&#44; y compararlas con las de c&#233;rvix&#59; as&#237; como analizar el porcentaje de mujeres que adquieren y aclaran la infecci&#243;n por genotipos oncog&#233;nicos del VPH en el canal anal y los factores predictores de la aparici&#243;n de dichos genotipos en ano&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Pacientes y m&#233;todos</span><p id="par0020" class="elsevierStylePara elsevierViewall">Dise&#241;o&#58; estudio prospectivo&#44; longitudinal&#44; unic&#233;ntrico&#44; compuesto por MVIH&#43; incluidas de forma consecutiva&#44; tras la firma del consentimiento informado&#44; en un programa de cribado&#44; diagn&#243;stico&#44; tratamiento y seguimiento de lesiones displ&#225;sicas de mucosa anal &#40;mayo de 2012-diciembre de 2016&#41;&#46; Las pacientes proced&#237;an de la consulta de enfermedades infecciosas de un hospital espa&#241;ol de tercer nivel&#46; El estudio fue evaluado y aprobado por el comit&#233; &#233;tico del centro donde se obtuvieron las participantes&#46; Criterios de inclusi&#243;n&#58; &#62;<span class="elsevierStyleHsp" style=""></span>18<span class="elsevierStyleHsp" style=""></span>a&#241;os&#44; MVIH&#43;&#46; Criterios de exclusi&#243;n&#58; hombres con infecci&#243;n por el VIH y antecedentes de neoplasia de canal anal&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">En la visita se explicaba a las pacientes las condiciones y los objetivos de la investigaci&#243;n&#44; se les facilitaba un documento de consentimiento informado para su firma y se recog&#237;an datos epidemiol&#243;gicos&#44; cl&#237;nicos y anal&#237;ticos que fueron tratados siguiendo la ley de protecci&#243;n de datos vigente &#40;Ley Org&#225;nica 15&#47;1999&#44; de 13 de diciembre&#44; de Protecci&#243;n de Datos de Car&#225;cter Personal&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">En la visita basal &#40;V1&#41; y posteriores &#40;Vx&#41; se recogieron&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Las variables cl&#237;nico&#47;epidemiol&#243;gicas&#58; edad&#44; antecedentes de condilomas perianal-genital y patolog&#237;a cervical &#40;CIN1&#47;2&#47;3&#44; CC&#41;&#59; sexo y n&#250;mero de parejas sexuales en los &#250;ltimos 12<span class="elsevierStyleHsp" style=""></span>meses y en toda su vida&#44; sexo anal&#44; uso de cond&#243;n&#44; tabaquismo&#44; consumo de alcohol &#40;unidades de bebida est&#225;ndar &#91;UBE&#93;&#41;&#44; adicci&#243;n a drogas por v&#237;a parenteral &#40;ADVP&#41;&#44; nacionalidad&#44; nivel de estudios&#44; meses de diagn&#243;stico de VIH&#44; estadio del VIH seg&#250;n la clasificaci&#243;n CDC&#59; meses en tratamiento antirretroviral &#40;TAR&#41;&#44; fracaso virol&#243;gico &#40;se consider&#243; cuando hab&#237;a ARN-viral &#62;<span class="elsevierStyleHsp" style=""></span>50<span class="elsevierStyleHsp" style=""></span>copias&#47;ml en al menos dos determinaciones en 6 meses previos&#41;&#44; uso de tratamiento concomitante&#46; Otras infecciones&#58; hepatopat&#237;a cr&#243;nica por virus de la hepatitis<span class="elsevierStyleHsp" style=""></span>B &#40;VHB&#41; o virus de la hepatitis<span class="elsevierStyleHsp" style=""></span>C &#40;VHC&#41;&#44; serolog&#237;a lu&#233;tica positiva y otras enfermedades de transmisi&#243;n sexual&#44; e infecci&#243;n tuberculosa latente&#44; tratada o activa&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">Las variables anal&#237;ticas incluidas fueron linfocitos CD4 nadir&#44; CD4 y carga viral al diagn&#243;stico del VIH&#59; CD4&#44; CD8 y carga viral en el momento de inclusi&#243;n en el estudio&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">En V1 y Vx se proced&#237;a a la toma de 2 muestras de la mucosa del canal anal con un par de torundas de algod&#243;n impregnadas en suero fisiol&#243;gico&#58; una para la detecci&#243;n y genotipado del VPH mediante una reacci&#243;n en cadena de la polimerasa &#40;PCR&#41; cualitativa <span class="elsevierStyleItalic">&#40;Linear Array HPV Genotyping Test&#41;</span>&#44; realizada con el termociclador GeneAmp PCR System 9700 &#40;Applied Biosystems&#44; Roche&#44; Suiza&#41;&#44; y la segunda para realizaci&#243;n de citolog&#237;a&#59; ambas muestras eran incluidas en medio l&#237;quido &#40;<span class="elsevierStyleItalic">liquid m&#233;dium</span>&#44; Thin Layer Liquid&#41;&#59; para el estudio citol&#243;gico se emple&#243; la t&#233;cnica <span class="elsevierStyleItalic">thin-layer</span> &#40;Procesador Thin Prep 2000&#44; Hologic&#41;&#46; Ambas muestras se enviaban al laboratorio de anatom&#237;a patol&#243;gica&#44; donde un mismo pat&#243;logo &#40;JE&#41; llevaba a cabo el dictamen de las citolog&#237;as y la validaci&#243;n de resultados de la PCR del VPH&#46; Los genotipos 16&#44; 18&#44; 26&#44; 31&#44; 33&#44; 35&#44; 39&#44; 45&#44; 51-53&#44; 56&#44; 58&#44; 59&#44; 66&#44; 68&#44; 73 y 82 fueron considerados de alto riesgo &#40;VPH-AR&#41;&#46; Los genotipos 6&#44; 11&#44; 34&#44; 40&#44; 42-44&#44; 54&#44; 55&#44; 57&#44; 61&#44; 70-72&#44; 81&#44; 83&#44; 84 y 89&#44; de bajo riesgo &#40;VPH-Br&#41;&#46; Se clasificaron como subespecies del genotipo VPH<span class="elsevierStyleHsp" style=""></span>18 los virus 39&#44; 45&#44; 59&#44; 68&#44; y del VPH<span class="elsevierStyleHsp" style=""></span>16&#44; los genotipos 31&#44; 33&#44; 35&#44; 52&#44; 58&#44; 67<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">17</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En las visitas &#40;V1 y Vx&#41; a las pacientes con citolog&#237;a anormal y&#47;o PCR de VPH de alto riesgo &#40;AR&#41; positiva se les hac&#237;a anoscopia de alta resoluci&#243;n &#40;AAR&#41;&#46; Las pacientes con AAR normal y PCR VPH-AR negativa eran evaluadas bianualmente con nueva citolog&#237;a y PCR&#59; aquellas con PCR del VPH positiva y&#47;o AAR con LSIL &#40;AIN1&#41; se evaluaban anualmente&#59; las diagnosticadas de HSIL o CA eran tratadas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46; El algoritmo de seguimiento &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41; lo desarrollamos a partir de datos propios sobre sobre sensibilidad&#44; especificidad&#44; valores predictivos positivo y negativo de la citolog&#237;a anal y de la PCR del VPH de alto riesgo para predecir HSIL<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">La AAR se efectuaba con el colposcopio Carl Zeiss 150 fc<span class="elsevierStyleSup">&#169;</span> &#40;Carl Zeiss&#44; Oberkochen&#44; Alemania&#41; en un intervalo de 4 a 12 semanas a la realizaci&#243;n de la citolog&#237;a anal&#46; Previa a la AAR se hac&#237;a inspecci&#243;n y tacto rectal&#44; tras lo cual se introduc&#237;a un anoscopio desechable transparente a trav&#233;s del cual se instilaban 5<span class="elsevierStyleHsp" style=""></span>ml de &#225;cido ac&#233;tico que se dejaban durante unos 3<span class="elsevierStyleHsp" style=""></span>min&#44; se retiraba y se inspeccionaba la mucosa&#59; posteriormente se instilaba lugol al 5&#37; un minuto y se volv&#237;a a inspeccionar&#46; Se tomaban muestras&#44; tanto de mucosa aparentemente normal de los 4 cuadrantes&#44; como de aquellas zonas sugerentes de displasia &#40;aceto-blanco&#47;lugol negativas&#41;&#46; Las biopsias se hac&#237;an con un cat&#233;ter de colangiopancreatograf&#237;a retr&#243;grada endosc&#243;pica &#40;CPRE&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La clasificaci&#243;n que empleamos para la citolog&#237;a anal y cervical fue la de Bethesda<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">18</span></a>&#44; que clasifica las lesiones en 4 tipos&#58; c&#233;lulas escamosas at&#237;picas &#40;<span class="elsevierStyleItalic">atypical squamous cells</span> &#91;ASC&#93;&#41;&#44; c&#233;lulas escamosas at&#237;picas en las que no se puede descartar c&#233;lulas de alto grado &#40;<span class="elsevierStyleItalic">atypical squamous cells-high</span> &#91;ASC-H&#93;&#41;&#44; lesi&#243;n intraepitelial de bajo grado &#40;<span class="elsevierStyleItalic">low-grade squamous intraepithelial lesions</span> &#91;LSIL&#93;&#41; y lesiones intraepiteliales de alto grado &#40;<span class="elsevierStyleItalic">high-grade squamous intraepithelial lesions</span> &#91;HSIL&#93;&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">La clasificaci&#243;n histol&#243;gica empleada fue la del consenso &#171;Squamous Terminology &#40;LAST&#41; Standardization&#160;Project for HPV&#187;&#44; tanto para ano como para c&#233;rvix&#46; Esta clasifica a las lesiones anales en LSIL &#40;AIN1&#47;condiloma&#41;&#44; HSIL &#40;AIN2&#47;AIN3&#41; y carcinoma de canal anal invasivo &#40;CA&#41;&#44; y a las cervicales como CIN1&#44; CIN2&#44; CIN3&#44; CC&#46; La P16 se emple&#243; seg&#250;n las recomendaciones del consenso LAST<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">19</span></a>&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">El estudio citol&#243;gico e histol&#243;gico fue realizado siempre por el mismo pat&#243;logo &#40;JE&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">En V1 y Vx las mujeres fueron enviadas al ginec&#243;logo para citolog&#237;a cervical &#40;se empleaba el mismo medio l&#237;quido que para la anal&#41;&#59; en caso de ser anormal&#44; se les realizaba colposcopia con tinci&#243;n de ac&#233;tico y lugol&#44; tras lo cual tomaban biopsia solo de las zonas aceto-blanco lugol-negativas&#46; Las muestras eran enviadas al mismo servicio de anatom&#237;a-patol&#243;gica&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Definici&#243;n de variables&#58;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Citolog&#237;a anormal&#58; la que incluye desde ASCUS&#44; ASCUS-H&#44; LSIL a HSIL&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Histolog&#237;a con lesi&#243;n anal HSIL&#43;&#58; inclu&#237;a desde HSIL &#40;AIN2&#44; AIN3&#41; a c&#225;ncer invasivo&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Histolog&#237;a con lesi&#243;n anal LSIL&#43;&#58; inclu&#237;a desde LSIL &#40;condiloma&#47;AIN1&#41; a c&#225;ncer invasivo&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Aclaramiento de la infecci&#243;n por VPH-AR&#58; cuando en una paciente que ten&#237;a en visita basal &#40;V1&#41; infecci&#243;n en mucosa anal por cualquier genotipo del VPH-AR&#44; no se detectaba ning&#250;n genotipo del VPH-AR en su &#250;ltima visita&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Adquisici&#243;n de infecci&#243;n por VPH-AR&#58; cuando en la &#250;ltima visita el paciente presentaba un nuevo genotipo del VPH-AR en mucosa anal que no ten&#237;a en visita basal &#40;V1&#41;&#46;</p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">An&#225;lisis estad&#237;stico</span><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Tama&#241;o muestral&#46;</span> Se incluyeron 95 mujeres de un total de 149 atendidas en la consulta externa de un servicio de enfermedades infecciosas perteneciente a un hospital de tercer nivel espa&#241;ol y que accedieron voluntariamente a formar parte del programa&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis descriptivo&#46;</span> Realizamos una descripci&#243;n de las principales variables recogidas en el estudio&#44; se calcularon medidas de tendencia central y dispersi&#243;n &#40;media&#44; desviaci&#243;n t&#237;pica&#44; mediana&#44; percentiles&#41; para las variables cuantitativas&#44; y frecuencias absolutas con intervalo de confianza del 95&#37; para las cualitativas&#46; Se calcul&#243; la prevalencia de VPH y los hallazgos de citolog&#237;a e histolog&#237;a de mucosa anal con intervalo de confianza del 95&#37;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis bivariante&#46;</span> Se emple&#243; para estudiar la relaci&#243;n entre los posibles factores de riesgo y la infecci&#243;n por VPH-AR&#46; Para las variables cuantitativas que segu&#237;an una distribuci&#243;n normal se aplic&#243; el test de la t de Student para muestras independientes&#59; para aquellas que no segu&#237;an una distribuci&#243;n normal&#44; el test de Mann-Whitney&#46; Para las variables cualitativas se emple&#243; el test de chi-cuadrado de Pearson&#44; o Fisher si no se cumpl&#237;an los criterios de aplicaci&#243;n&#46; Para comprobar si las diferentes variables cumpl&#237;an la hip&#243;tesis de normalidad&#44; se utiliz&#243; el test de Kolmogorov-Smirnov&#46; Para todos los test se consider&#243; un nivel de significaci&#243;n de 0&#44;05&#46; El software estad&#237;stico utilizado fue el SPSS 20&#46;0&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">An&#225;lisis multivariante&#46;</span> Se realiz&#243; mediante regresi&#243;n de Poisson&#44; empleando el Stata Statistical Software&#58; Release 12&#44; con varianza robusta del error&#44; calculando el riesgo relativo &#40;RR&#41;&#44; as&#237; como su intervalo de confianza del 95&#37;&#46; Realizamos este tipo de regresi&#243;n bas&#225;ndonos en la elevada prevalencia de la infecci&#243;n anal por VPH-AR de nuestra cohorte de mujeres infectadas por VIH&#44; por lo que resultaba m&#225;s adecuado calcular el RR que la odds ratio&#46; El m&#233;todo de selecci&#243;n de variables fue por pasos sucesivos hacia atr&#225;s&#44; considerando como criterio de entrada p<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#44;05 y de salida p<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#44;10&#46; En el modelo se incluyeron tanto las variables que hab&#237;an resultado estad&#237;sticamente significativas en el an&#225;lisis bivariante&#44; como las cl&#237;nicamente relevantes&#44; quedando finalmente compuesto por las siguientes&#58; n&#250;mero de parejas sexuales en toda su vida mayor de<span class="elsevierStyleHsp" style=""></span>3&#44; tabaquismo&#44; citolog&#237;a anal y cervical anormales&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Resultados</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Caracter&#237;sticas basales de las pacientes incluidas</span><p id="par0140" class="elsevierStylePara elsevierViewall">Se incluyeron 95 mujeres de 43&#44;7<span class="elsevierStyleHsp" style=""></span>a&#241;os de edad media &#40;el 75&#44;8&#37; se encontraban entre los 30 y los 50<span class="elsevierStyleHsp" style=""></span>a&#241;os&#41;&#46; La mediana de tiempo de evoluci&#243;n del VIH era de 13&#44;6<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;P25-P75&#58; 6&#44;8-21&#44;2&#41;&#59; CD4 nadir 213&#44;7<span class="elsevierStyleHsp" style=""></span>c&#233;lulas&#47;&#956;l&#44; el 93&#44;6&#37; en tratamiento antirretroviral&#44; durante 10<span class="elsevierStyleHsp" style=""></span>a&#241;os &#40;P25-P75&#58; 5-16&#44;8&#41;&#44; con una media de CD4 648&#44;7<span class="elsevierStyleHsp" style=""></span>c&#233;lulas&#47;&#956;l &#40;Cd4&#47;CD8&#58; 0&#44;95&#41;&#44; y el 7&#44;8&#37; en fracaso virol&#243;gico&#59; el resto de variables se encuentran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">El 29&#44;5&#37; no hab&#237;an cursado ning&#250;n tipo de estudio&#44; el 46&#44;3&#37; hab&#237;an tenido m&#225;s de 3 parejas sexuales en toda su vida y el 28&#44;4&#37; sexo anal&#46; El 64&#44;2&#37; eran fumadoras&#44; el 11&#44;6&#37; ten&#237;an verrugas genitales&#47;perianales y el 18&#44;9&#37;&#44; antecedentes de patolog&#237;a de c&#233;rvix &#40;9&#44;5&#37; CIN1&#44; 6&#44;3&#37; CIN2&#44; 1&#44;05&#37; CIN3&#44; 2&#44;1&#37; CC&#41;&#59; el resto de variables se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Resultados de citolog&#237;as&#44; biopsias y PCR del VPH&#44; visita basal</span><p id="par0150" class="elsevierStylePara elsevierViewall">El 92&#44;6&#37; de las MVIH&#43; ten&#237;an una citolog&#237;a cervical normal&#44; el 4&#44;2&#37; ASCUS&#44; el 5&#44;2&#37; LSIL y el 3&#44;2&#37; HSIL &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; En cuanto a los resultados de la citolog&#237;a anal&#44; encontramos que el 68&#44;4&#37; de las pacientes ten&#237;an una citolog&#237;a normal&#44; el 25&#44;3&#37; LSIL&#44; el 2&#44;1&#37; HSIL y el 4&#44;2&#37; ASCUS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#44; con diferencias estad&#237;sticamente significativas entre ambos tipos de citolog&#237;as &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0155" class="elsevierStylePara elsevierViewall">Por otra parte&#44; en cuanto a los resultados de la PCR del VPH en ano&#44; el 49&#44;4&#37; de las mujeres &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 39-60&#41; ten&#237;an infecci&#243;n por genotipos de alto riesgo&#44; con una mediana de genotipos oncog&#233;nicos por paciente de 0 &#40;P25-P75&#58; 0-1&#41;&#59; el 40&#37;&#44; de bajo riesgo &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 29-51&#41;&#44; con una mediana de 0 &#40;P25-P75&#58; 0-1&#41;&#44; y el 31&#37; ten&#237;an infecci&#243;n simult&#225;nea por genotipos de bajo y alto riesgo &#40;IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 21-41&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Los genotipos de VPH m&#225;s frecuentemente aislados en la mucosa anal fueron&#58; de bajo riesgo el 6 &#40;14&#44;3&#37;&#41;&#44; el 42 &#40;8&#44;3&#37;&#41;&#44; el 62 &#40;7&#44;1&#37;&#41;&#44; el 73 &#40;4&#44;8&#37;&#41; y el 84 &#40;4&#44;8&#37;&#41;&#44; y de alto riesgo el 16 &#40;19&#37;&#41;&#44; el 45 &#40;8&#44;3&#37;&#41;&#44; el 51 &#40;8&#44;3&#37;&#41; y el 55 &#40;8&#44;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0160" class="elsevierStylePara elsevierViewall">De las 42 AAR realizadas&#44; el 38&#44;1&#37; eran normales&#44; el 50&#37; LSIL &#40;AIN 1&#41;&#44; el 9&#44;5&#37; HSIL &#40;AIN2&#47;3&#41; y el 2&#44;4&#37; CA &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; De las 12 colposcopias realizadas&#44; el 5&#44;2&#37; fueron normales&#44; el 4&#44;2&#37; CIN1&#44; el 1&#44;05&#37; CIN2&#44; el 1&#44;05&#37; CIN3 y el 1&#44;05&#37; CC&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Resultados del seguimiento</span><p id="par0165" class="elsevierStylePara elsevierViewall">Durante los 36 meses &#40;P25-75&#58; 24&#44;8-47&#44;3&#41; de mediana de seguimiento&#44; tres mujeres desarrollaron nuevos casos de HSIL anal&#44; cuya incidencia era de 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#46;000 personas-a&#241;o&#46; El 14&#44;8&#37; adquirieron VPH-AR y el 51&#44;2&#37; los aclararon&#44; con diferencias estad&#237;sticamente significativas &#40;p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Dos mujeres fueron <span class="elsevierStyleItalic">exitus letalis</span>&#44; una por un c&#225;ncer anal a los 24 meses del diagn&#243;stico&#44; que se realiz&#243; en la visita basal&#44; a la que se le administr&#243; radioterapia&#44; quimioterapia y amputaci&#243;n abdominop&#233;lvica&#44; y otra por recidiva de un linfoma de Hodgkin&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">De las 8 mujeres que tuvieron lesiones precursoras de CA &#40;HSIL&#41; en la cohorte&#44; una de ellas rehus&#243; recibir tratamiento y en la revisi&#243;n a los 12<span class="elsevierStyleHsp" style=""></span>meses la lesi&#243;n &#40;AIN2&#41; hab&#237;a desaparecido&#44; ten&#237;a LSIL &#40;AIN1&#41;&#46; Otra recibi&#243; imiquimod intra-anal 3 veces por semana durante 16 semanas sin respuesta e incluso progresi&#243;n&#44; con mayor afectaci&#243;n de los cuadrantes de 1 a 3&#44; por lo que requiri&#243; electrocauterizaci&#243;n&#47;fulguraci&#243;n de las lesiones con bistur&#237;&#59; las otras 6 restantes&#44; recibieron electrocauterizaci&#243;n&#47;fulguraci&#243;n&#46; El 100&#37; de las pacientes tratadas no volvieron a presentar lesiones precursoras ni CA durante una mediana de seguimiento de 30&#44;5<span class="elsevierStyleHsp" style=""></span>meses &#40;P25-P75&#58; 17&#44;5-36&#44;5&#41;&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">Ninguna de las mujeres present&#243; durante el seguimiento CIN1&#44; CIN2&#44; CIN3 o CC&#46; El 1&#44;05&#37; present&#243; neoplasia intraepitelail de vulva grado<span class="elsevierStyleHsp" style=""></span>1 &#40;VIN1&#41; y el 1&#44;05&#37;&#44; VIN3&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Factores predictores de infecci&#243;n por VPH-AR</span><p id="par0185" class="elsevierStylePara elsevierViewall">En el an&#225;lisis bivariante encontramos como factores de riesgo para la infecci&#243;n anal por el VPH-AR el antecedente de infecci&#243;n de transmisi&#243;n sexual &#40;ITS&#41; &#40;26&#44;2&#37; vs&#46; 4&#44;7&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;006&#41;&#59; displasia de c&#233;rvix &#40;19&#44;1&#37; vs&#46; 0&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;005&#41;&#59; citolog&#237;a anal an&#243;mala &#40;50&#37; vs&#46; 16&#44;3&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;001&#41;&#44; y n&#250;mero de parejas sexuales en toda su vida superior a 3 &#40;64&#44;3&#37; vs&#46; 30&#44;2&#37;&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;002&#41;&#46; El resto de variables pueden consultarse en la <a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0190" class="elsevierStylePara elsevierViewall">Finalmente&#44; en el an&#225;lisis multivariante encontramos como factores de riesgo para infecci&#243;n anal por genotipos oncog&#233;nicos el tabaquismo &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;99-2&#44;42&#41;&#44; n&#250;mero de parejas sexuales superior a 3 &#40;RR&#58; 1&#44;69&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;09-2&#44;62&#41;&#44; displasia cervical &#40;RR&#58; 1&#44;83&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;26-2&#44;67&#41; y anal &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;021-2&#44;35&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discusi&#243;n</span><p id="par0195" class="elsevierStylePara elsevierViewall">Una de cada 10 mujeres VIH positiva de nuestra cohorte ten&#237;a una lesi&#243;n anal precursora de c&#225;ncer asociada al VPH&#44; con una incidencia de 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#46;000 personas-a&#241;o&#44; y hasta el 50&#37; presentaron lesi&#243;n de bajo grado &#40;LSIL&#47;AIN1&#41;&#46; En un estudio comparativo entre mujeres seropositivas vs&#46; seronegativas encontraron una tasa de HSIL en mujeres infectadas por el VIH similar a la nuestra&#44; del 9&#37;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">20</span></a>&#59; sin embargo&#44; la prevalencia de LSIL que hallaron fue muy inferior&#44; tan solo del 12&#37;&#46; La diferencia con nuestros resultados podr&#237;a atribuirse a que en ese estudio la anoscopia solo era realizada en caso de citolog&#237;a an&#243;mala&#59; en nuestro caso&#44; y bas&#225;ndonos en datos propios sobre la sensibilidad de la citolog&#237;a y de la PCR del VPH en el cribado de HSIL<a class="elsevierStyleCrossRef" href="#bib0240"><span class="elsevierStyleSup">14</span></a>&#44; se hac&#237;a tanto en mujeres con citolog&#237;a displ&#225;sica como con PCR positiva de cualquier genotipo oncog&#233;nico del VPH&#46; En otro trabajo realizado solo en MVIH&#43; la tasa de HSIL&#43; fue del 12&#37;&#44; y como principales factores de riesgo para este tipo de lesi&#243;n encontraron patolog&#237;a cervical e infecci&#243;n anal por el genotipo<span class="elsevierStyleHsp" style=""></span>16<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">21</span></a>&#46; Sin embargo&#44; en un estudio retrospectivo&#44; compuesto por 745 MVIH&#43;&#44; la prevalencia de HSIL fue muy superior&#44; hasta del 26&#37;&#44; lo que se asociaba a tabaquismo y citolog&#237;a cervical anormal<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">22</span></a>&#46; Por &#250;ltimo&#44; una revisi&#243;n sistem&#225;tica sobre las lesiones precursoras de c&#225;ncer de ano asociado al VPH en MVIH&#43; mostraba variabilidad en las cifras de prevalencias en dichas lesiones al comparar las diferentes cohortes&#44; de forma que oscilaban entre el 3 y y el 26&#37;&#46; Al comparar en nuestra cohorte la prevalencia de HSIL&#43; anal frente a la de c&#233;rvix descubrimos una mayor tasa de displasia en ano&#44; con diferencias estad&#237;sticamente significativas&#46; Por otra parte&#44; durante los 3<span class="elsevierStyleHsp" style=""></span>a&#241;os de mediana de seguimiento no hallamos ning&#250;n caso de lesi&#243;n precursora cervical&#44; ni de c&#225;ncer de c&#233;rvix&#46; Estos resultados eran congruentes con los comunicados hasta el momento en la literatura&#44; en los que la incidencia de CC se ha ido reduciendo de forma paulatina en las cohortes de mujeres infectadas por el VIH gracias&#44; entre otros factores&#44; a la introducci&#243;n del tratamiento antirretroviral<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">23</span></a>&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">En cuanto al c&#225;ncer de ano&#44; la prevalencia que descubrimos en nuestra cohorte fue superponible a la de CC&#44; inferior al 3&#37; en ambos casos&#59; en los 36<span class="elsevierStyleHsp" style=""></span>meses de mediana de seguimiento ninguna mujer volvi&#243; a presentar c&#225;ncer anogenital&#44; y las que fueron diagnosticadas y tratadas de lesi&#243;n precursora asociada al VPH tampoco experimentaron progresi&#243;n a CA&#59; incluso una de ellas&#44; con HSIL anal&#44; regres&#243; espont&#225;neamente&#46; Esto podr&#237;a deberse&#44; entre otras causas&#44; a que m&#225;s del 90&#37; estaban en tratamiento antirretroviral y ten&#237;an un excelente estado viro-inmunol&#243;gico&#46; En un metaan&#225;lisis realizado en pacientes seropositivos sobre la infecci&#243;n anal por VPH y lesiones neopl&#225;sicas asociadas a dicha infecci&#243;n&#44; hallaron que la progresi&#243;n de neoplasia intraepitelial anal a c&#225;ncer de ano era m&#225;s baja que la de CIN3 a c&#225;ncer de c&#233;rvix &#40;1 en 600<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>a&#241;o en hombres que tienen sexo con hombres seropositivos vs&#46; 1 en 80<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>a&#241;o en mujeres&#41;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">24</span></a>&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">El CA es una enfermedad no definitoria de sida&#44; muy prevalente en poblaci&#243;n VIH positiva vs&#46; poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0295"><span class="elsevierStyleSup">25</span></a>&#59; en mujeres infectadas por el VIH se ha comunicado una incidencia variable entre 3&#44;9 a 30<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#46;000 personas-a&#241;o&#44; cifras que se llegan a incrementan hasta 63&#44;8 casos por 100&#46;000 persona-a&#241;o en aquellas con CC o CIN3&#46; Publicaciones recientes realizadas sobre cohortes de pacientes infectados por el VIH hombres que tienes sexo con hombres recogen el efecto protector del TAR frente a la aparici&#243;n de lesiones precursoras y CA asociadas al VPH<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">9-11&#44;26&#44;27</span></a>&#44; hecho que podr&#237;a explicar nuestros hallazgos&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">En cuanto a la prevalencia de la infecci&#243;n por VPH en la mucosa anal de nuestras mujeres&#44; encontramos que hasta la mitad de ellas estaban infectadas por genotipos de alto riesgo&#44; 2&#47;5 por bajo riesgo y 1&#47;3 por ambos genotipos&#46; El genotipo VPH<span class="elsevierStyleHsp" style=""></span>16 fue el m&#225;s frecuentemente aislado en mucosa anal&#44; casi en una de cada cinco pacientes&#44; y de los de bajo riesgo&#44; fue el genotipo<span class="elsevierStyleHsp" style=""></span>6&#46; Un estudio publicado recientemente sobre prevalencia del VPH en MVIH&#43; mostraba que aproximadamente la mitad de las pacientes estaban infectadas por genotipos oncog&#233;nicos&#44; siendo el m&#225;s frecuente el 16&#44; datos muy similares a los de nuestro estudio<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a>&#46; En la cohorte prospectiva Sun Study&#44; compuesta por 120 MVIH&#43;&#44; hallaron una prevalencia del 85&#37; de dichos genotipos en ano&#59; la diferencia con nuestros datos y los previos<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a> puede deberse&#44; en parte&#44; a que dicha cohorte&#44; en comparaci&#243;n con la nuestra&#44; ten&#237;a un menor porcentaje de pacientes en tratamiento antirretroviral &#40;TAR&#41;&#44; en supresi&#243;n virol&#243;gica y con CD4<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>500<span class="elsevierStyleHsp" style=""></span>c&#233;lulas&#47;ml &#40;solo el 77&#44; el 73 y el 36&#37;&#44; respectivamente&#41;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">29</span></a>&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">Por otra parte&#44; encontramos que la adquisici&#243;n de genotipos de alto riesgo ocurr&#237;a en una de cada 7 mujeres&#44; y aunque m&#225;s de la mitad los aclaraba durante el seguimiento&#44; la incidencia de HSIL anal en nuestra cohorte era elevada&#46; Un estudio retrospectivo del <span class="elsevierStyleItalic">AIDS Clinical Trials Group</span> &#40;ACTG&#41; A5029 mostr&#243; que MVIH&#43; en tratamiento antirretroviral con CD4<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>350<span class="elsevierStyleHsp" style=""></span>c&#233;lulas&#47;&#956;l ten&#237;an mayor tasa de aclaramiento&#44; y en el caso de carga viral del VIH<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>400<span class="elsevierStyleHsp" style=""></span>copias&#47;ml&#44; superior tasa de adquisici&#243;n<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">30</span></a>&#59; estos datos podr&#237;an explicar nuestros resultados&#44; ya que el 93&#44;6&#37; de nuestras pacientes recib&#237;an TAR&#44; ten&#237;an una media de CD4 648&#44;7<span class="elsevierStyleHsp" style=""></span>c&#233;lulas&#47;&#956;l&#44; y solo el 7&#44;8&#37; se encontraban en fracaso virol&#243;gico&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">Al analizar los posibles factores predictores de infecci&#243;n por genotipos oncog&#233;nicos de la mucosa anal descubrimos que los que se relacionaban de forma estad&#237;sticamente significativa fueron el tabaquismo&#44; el n&#250;mero de parejas sexuales en toda su vida mayor a tres&#44; la displasia cervical y la anal&#44; datos en consonancia con los comunicados en 2016 por el grupo de estudio ANRS-C017 VIHGY&#44; que descubrieron en MVIH&#43; como factores asociados a la infecci&#243;n anal por virus oncog&#233;nicos&#58; presencia de citolog&#237;a cervical displ&#225;sica&#44; infecci&#243;n cervical por VPH de alto riesgo y CD4<span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>350<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;ml&#46; Esta cohorte ten&#237;a una tasa de TAR y CD4<span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>500<span class="elsevierStyleHsp" style=""></span>c&#233;l&#47;ml&#44; cercanas al 100&#37;&#44; y se encontraban en supresi&#243;n virol&#243;gica m&#225;s del 80&#37; de las pacientes<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">28</span></a>&#46; El consumo de tabaco en pacientes VIH positivos tambi&#233;n ha sido relacionado previamente con la presencia de displasia de canal anal<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">31</span></a>&#44; as&#237; como con la infecci&#243;n por virus de alto riesgo en c&#233;rvix y lesiones CIN2&#43; en MVIH&#43;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">32</span></a>&#46; En cuanto a los h&#225;bitos sexuales&#44; tanto el tipo de relaci&#243;n como el mayor n&#250;mero de parejas sexuales han sido considerados factores cl&#225;sicos de la infecci&#243;n por VPH oncog&#233;nicos en mucosa anal<a class="elsevierStyleCrossRef" href="#bib0335"><span class="elsevierStyleSup">33</span></a>&#46;</p><p id="par0225" class="elsevierStylePara elsevierViewall">Una de las principales limitaciones de nuestro estudio deriva del dise&#241;o unic&#233;ntrico y&#44; por otra parte&#44; del hecho de que no dispusi&#233;ramos de la PCR del VPH procedente del c&#233;rvix &#40;por problemas ajenos a los investigadores y en relaci&#243;n con los presupuestos&#41;&#44; as&#237; como de las derivadas de los criterios de exclusi&#243;n&#46; En cuanto a las fortalezas&#44; se encuentran el dise&#241;o del estudio&#44; longitudinal-prospectivo&#59; el que las pacientes eran llevadas siempre por el mismo cl&#237;nico que se encargaba de la toma de muestras&#44; as&#237; como de la AAR&#44; y finalmente&#44; que la citolog&#237;a y la histolog&#237;a eran interpretadas por el mismo pat&#243;logo&#46;</p><p id="par0230" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en este per&#237;odo tard&#237;o del tratamiento antirretroviral la prevalencia y la incidencia de lesiones precursoras de c&#225;ncer anal asociadas al VPH en nuestra cohorte de MVIH&#43; era superior a las de c&#233;rvix&#44; a pesar de que el aclaramiento de genotipos oncog&#233;nicos en mucosa anal fuese mayor al de adquisici&#243;n&#59; por ello&#44; creemos que se deber&#237;a ofertar el cribado de dichas lesiones a todas las mujeres infectadas por el VIH&#44; haciendo especial hincapi&#233; en las fumadoras&#44; con mayor n&#250;mero de parejas sexuales o displasia anogenital indistintamente&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicto de intereses</span><p id="par0235" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2017-07-13"
    "fechaAceptado" => "2017-10-12"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1041682"
          "palabras" => array:5 [
            0 => "Virus del papiloma humano de alto riesgo"
            1 => "Mujeres seropositivas"
            2 => "C&#225;ncer de c&#233;rvix"
            3 => "C&#225;ncer de ano"
            4 => "Lesiones precursoras de c&#225;ncer de ano"
          ]
        ]
      ]
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1041683"
          "palabras" => array:5 [
            0 => "High-risk human papillomavirus"
            1 => "Women living with HIV"
            2 => "Cervical cancer"
            3 => "Anal cancer"
            4 => "Anal cancer precursor lesions"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">El c&#225;ncer de ano &#40;CA&#41; es uno de los tumores no definitorios de sida m&#225;s frecuentes&#44; principalmente en hombres que tienen sexo con hombres y mujeres infectadas por VIH&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objetivos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Evaluar la prevalencia e incidencia de lesiones precursoras &#40;HSIL&#41; y CA en nuestra cohorte de mujeres&#44; y compararlas con las de c&#233;rvix&#59; analizar el porcentaje de pacientes que adquieren y aclaran genotipos oncog&#233;nicos &#40;VPH-AR&#41; del canal anal&#59; y los factores predictores para dicha infecci&#243;n en ano&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Paciente y m&#233;todos</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo-longitudinal &#40;mayo de 2012-diciembre de 2016&#41;&#46; En visita basal &#40;V1&#41; y posteriores se tomaban muestras de mucosa anal en medio l&#237;quido para citolog&#237;a&#44; y PCR del VPH&#46; En caso de citolog&#237;a anal patol&#243;gica y&#47;o PCR del VPH-AR positiva se realizaba anoscopia de alta resoluci&#243;n&#46; Adem&#225;s&#44; se enviaban al ginec&#243;logo&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Noventa y cinco mujeres de 43&#44;7<span class="elsevierStyleHsp" style=""></span>a&#241;os fueron incluidas&#46; En V1&#44; el 11&#44;6&#37; ten&#237;an patolog&#237;a cervical &#40;4&#44;1&#37; CIN1&#59; 2&#44;2&#37; CIN2&#47;3&#59; 1&#44;1&#37; c&#225;ncer de c&#233;rvix &#91;<span class="elsevierStyleSmallCaps">CC</span>&#93;&#41;&#59; el 64&#44;3&#37; presentaban patolog&#237;a anal &#40;50&#37; LSIL&#47;AIN1&#44; 9&#44;5&#37; HSIL&#47;AIN2&#47;3 y 2&#44;4&#37; CA&#41; y el 49&#44;4&#37;&#44; infecci&#243;n por VPH-AR&#46; Durante 36<span class="elsevierStyleHsp" style=""></span>meses de seguimiento la incidencia de HSIL anal fue de 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#46;000 persona-a&#241;o&#59; el 14&#44;8&#37; adquirieron VPH-AR y el 51&#44;2&#37; los aclararon&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#59; ninguna present&#243; CIN1&#47;2&#47;3 o CC&#46; En el an&#225;lisis multivariante encontramos como factores predictores de infecci&#243;n por VPH-AR&#58; tabaquismo &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;99-2&#44;42&#41;&#44; n&#250;mero de parejas sexuales &#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;RR&#58; 1&#44;69&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;09-2&#44;62&#41;&#44; displasia cervical &#40;RR&#58; 1&#44;83&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;26-2&#44;67&#41; y anal &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;021-2&#44;35&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusiones</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">A pesar de que el aclaramiento de genotipos oncog&#233;nicos en ano era mayor que la adquisici&#243;n&#44; la prevalencia e incidencia de HSIL era elevada&#44; y superior a la de c&#233;rvix&#44; por lo que quiz&#225; deber&#237;a ofertarse el cribado de dichas lesiones a todas las mujeres seropositivas&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objetivos"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Paciente y m&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusiones"
          ]
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      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introduction</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Anal cancer is one of the most common non-AIDS defining malignancies&#44; especially in men who have sex with men and women living with HIV &#40;WLHIV&#41;&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objectives</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">To evaluate the prevalence and incidence of precursor lesions &#40;high-grade squamous intraepithelial lesions &#91;HSIL&#93;&#41; and anal cancer in our cohort of women and to compare them to cervical lesions&#59; to calculate the percentage of patients that acquire and clear oncogenic genotypes &#40;HR-HPV&#41; in the anal canal&#59; and to determine predictive factors for anal HPV infection&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Patients and methods</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prospective-longitudinal study &#40;May 2012-December 2016&#41;&#46; At baseline &#40;V1&#41; and follow up visits&#44; anal mucosa samples were taken in liquid medium for cytology and HPV PCR&#46; In cases of abnormal anal cytology and&#47;or positive HR-HPV PCR results&#44; a high resolution anoscopy was performed&#46; Patients were also referred to the gynaecologist&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Ninety five women with an average age of 43&#46;7<span class="elsevierStyleHsp" style=""></span>years were included&#46; At baseline&#44; 11&#46;6&#37; had cervical abnormalities &#40;4&#46;1&#37; CIN1&#44; 2&#46;2&#37; CIN2&#47;3&#44; 1&#46;1&#37; cervical cancer&#41;&#44; 64&#46;3&#37; anal abnormalities &#40;50&#37; LSIL&#47;AIN1&#44; 9&#46;5&#37; HSIL&#47;AIN2&#47;3 and 2&#46;4&#37; anal cancer&#41; and 49&#46;4&#37; had HR-HPV genotypes&#46; During 36<span class="elsevierStyleHsp" style=""></span>months of follow up&#44; the incidence of anal HSIL was 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#44;000 person-years&#59; 14&#46;8&#37; acquired HR-HPV genotypes and 51&#46;2&#37; cleared them&#44; <span class="elsevierStyleItalic">P</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>&#46;007&#46; No patients presented CIN1&#47;2&#47;3&#47; or cervical cancer&#46; In the multivariate analysis we found the following predictive factors for HR-HPV infection&#58; smoking &#40;RR&#58; 1&#46;55&#44; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 0&#46;99-2&#46;42&#41;&#44; number of sexual partners &#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;RR&#58; 1&#46;69&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;09-2&#46;62&#41;&#44; cervical and anal dysplasia &#40;RR&#58; 1&#46;83&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;26-2&#46;67&#41; and &#40;RR&#58; 1&#46;55&#59; 95&#37;<span class="elsevierStyleHsp" style=""></span>CI&#58; 1&#46;021-2&#46;35&#41;&#44; respectively&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates&#44; prevalence and incidence of HSIL were still high and greater than cervical HSIL&#46; Therefore&#44; screening for these lesions should perhaps be offered to all WLHIV&#46;</p></span>"
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            "identificador" => "abst0030"
            "titulo" => "Introduction"
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            "identificador" => "abst0035"
            "titulo" => "Objectives"
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            "identificador" => "abst0040"
            "titulo" => "Patients and methods"
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            "identificador" => "abst0045"
            "titulo" => "Results"
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            "identificador" => "abst0050"
            "titulo" => "Conclusions"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Algoritmo de seguimiento&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">AAR&#58; anoscopia de alta resoluci&#243;n&#59; AIN&#58; neoplasia intraepitelial anal&#59; ASC&#58; c&#233;lulas at&#237;picas&#59; CA&#58; c&#225;ncer de ano&#59; HSIL&#58; lesi&#243;n intraepitelial de alto grado&#59; LSIL&#58; lesi&#243;n intraepitelial de bajo grado&#59; PCR-VPH&#58; <span class="elsevierStyleItalic">Protein Chain Reaction</span> del virus del papiloma humano&#46;</p>"
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          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Flujo de pacientes desde la citolog&#237;a anal y PCR del VPH-AR a la AAR&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">AAR&#58; anoscopia de alta resoluci&#243;n&#59; AIN&#58; neoplasia intraepitelial anal&#59; ASCUS&#58; c&#233;lulas at&#237;picas&#59; CA&#58; c&#225;ncer de ano&#59; HSIL&#58; lesi&#243;n intraepitelial de alto grado&#59; LSIL&#58; lesi&#243;n intraepitelial de bajo grado&#59; PCR-VPH&#58; <span class="elsevierStyleItalic">Protein Chain Reaction</span> del virus del papiloma humano&#46;</p>"
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          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Prevalencia de los genotipos de VPH&#46;</p>"
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          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">CV&#58; carga viral del VIH&#59; EXADVP&#58; ex-adicta a drogas v&#237;a parenteral&#59; ITS&#58; infecci&#243;n de transmisi&#243;n sexual&#59; MVIH&#43;&#58; mujeres VIH positivas&#59; VHB&#58; infecci&#243;n cr&#243;nica por el virus de la hepatitis B&#59; VHC&#58; infecci&#243;n cr&#243;nica por el virus de la hepatitis C&#59; UBE&#58; unidad de bebida est&#225;ndar&#46;</p>"
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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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MVIH&#43; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;7 &#40;&#177; 8&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-50 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;75&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>&#62;50 a&#241;os n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;17&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Infecci&#243;n cr&#243;nica por VHC&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">24 &#40;25&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Infecci&#243;n cr&#243;nica por VHB&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes de condiloma anal&#47;genital n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Condiloma anal&#47;genital en visita basal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Historia de ITS&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;15&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Antecedentes de patolog&#237;a cervical&#44; n&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;9&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;6&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C&#225;ncer de c&#233;rvix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tabaquismo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">61 &#40;64&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">EXADVP&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Consumo de alcohol&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Alcohol &#40;UBE&#41; &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">95</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Forma de adquisici&#243;n del VIH&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heterosexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">72 &#40;75&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ADVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vertical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Desconocida&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Tiempo de evoluci&#243;n del VIH &#40;a&#241;os&#41; &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13&#44;6 &#40;6&#44;8-21&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 diagn&#243;stico de VIH &#40;c&#233;l&#47;&#956;l&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">362&#44;6 &#40;&#177; 315&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 nadir &#40;c&#233;l&#47;ul&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">213&#44;7 &#40;&#177; 172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 nadir &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">200 c&#233;l&#47;&#956;l&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">46 &#40;48&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 en visita basal &#40;c&#233;l&#47;&#956;l&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">645&#44;6 &#40;&#177; 372&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD8 en vista basal &#40;c&#233;l&#47;&#956;l&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">797&#44;6 &#40;&#177; 361&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CV del VIH en visita basal &#40;log&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4&#44;8 &#40;&#177; 4&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Historia previa de sida&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">49 &#40;51&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Toma TAR&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">89 &#40;93&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Fracaso virol&#243;gico&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;7&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mediana de meses de TAR &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">95&#44;5 &#40;18-172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas basales de la cohorte</p>"
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                0 => """
                  <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="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MVIH<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><br>n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Nivel de estudios</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Sin estudios primarios&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;29&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">40 &#40;42&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secundaria&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">20 &#40;21&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Universitario&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;7&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Jubilado&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">25 &#40;26&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Procedencia&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Europa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">81 &#40;85&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#193;frica&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;11&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad de inicio sexo &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17&#44;2 &#40;&#177; 3&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo en 12 meses previos&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">66 &#40;69&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mediana de parejas sexuales en su vida &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;2-10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#37; de pacientes con parejas sexuales en su vida &#62; 3&#44; n&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44 &#40;46&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mediana de parejas sexuales 12 meses previos &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo anal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;28&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Uso de cond&#243;n habitualmente&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">35 &#40;53&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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          "es" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas demogr&#225;ficas y relacionadas con h&#225;bitos sexuales</p>"
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        "etiqueta" => "Tabla 3"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CIN&#58; neoplasia intraepitelial de c&#233;rvix&#59; VPH&#58; virus papiloma humano&#59; VPH-AR&#58; VPH de alto riesgo&#44; VPH-BR&#58; VPH de bajo riesgo&#46;</p>"
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                0 => """
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                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">MVIH&#43; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Citolog&#237;a cervical&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">88 &#40;92&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ASCUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LSIL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HSIL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;3&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Colposcopia&#44; n&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">4 &#40;4&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>C&#225;ncer de c&#233;rvix&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1&#44;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">PCR de VPH</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VPH-AR&#44; n &#40;&#37;&#41; &#91;IC 95&#37;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">42 &#40;49&#44;4&#41; &#91;39-60&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VPH-BR&#44; n &#40;&#37;&#41; &#91;IC 95&#37;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;40&#41; &#91;29-51&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>VPH-AR y BR&#44; n &#40;&#37;&#41; &#91;IC 95&#37;&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">26 &#40;31&#41; &#91;21-41&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana de VPH-AR &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Mediana de VPH-BR &#40;P<span class="elsevierStyleInf">25</span>-P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Con HPV-AR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Sin HPV-AR &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariante&#58; p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariante&#58; RR 95&#37;CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad media &#40;a&#241;os&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">44&#44;5 &#40;&#177; 7&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">43&#44;4 &#40;&#177;8&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>30 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;2&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30-50 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">34 &#40;79&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62; 50 a&#241;os&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">10 &#40;23&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Jubilado&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;30&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;25&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo anal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">15 &#40;35&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;25&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexo en 12 meses&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">28 &#40;66&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">31 &#40;72&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Parejas sexuales 12 meses &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;0-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1 &#40;1-1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Parejas sexuales en su vida &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">5 &#40;3-20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2&#44;5 &#40;1&#44;7-5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;69 &#40;1&#44;09-2&#44;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#37; de parejas sexuales &#62; 3&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">27 &#40;64&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">13 &#40;30&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Edad inicio relaciones sexuales &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">-</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">P75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;15-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;16-18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Uso de cond&#243;n&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">17 &#40;40&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">16 &#40;37&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;83 &#40;1&#44;25-2&#44;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Verrugas genital&#47;anal&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;19&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">3 &#40;6&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;55 &#40;1&#44;02-2&#44;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Displasia de c&#233;rvix previa</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">9 &#40;21&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">6 &#40;13&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Citolog&#237;a anormal de c&#233;rvix actual</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">8 &#40;19&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Citolog&#237;a anormal de mucosa anal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">7 &#40;16&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Historia previa de&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ITS&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">11 &#40;26&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">2 &#40;4&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Tabaquismo&#44; n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">30 &#40;71&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;53&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">1&#44;55 &#40;0&#44;99-2&#44;44&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">180 &#40;36-264&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">153 &#40;67&#44;2-245&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 al diagn&#243;stico VIH &#40;c&#233;l&#46;&#47;ul&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">359&#44;7 &#40;&#177;274&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">349&#44;5 &#40;&#177;362&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 nadir &#40;c&#233;l&#46;&#47;ul&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">210&#44;3 &#40;&#177;190&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">199&#44;9 &#40;&#177;162&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 nadir &#60;</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">200 c&#233;l&#46;&#47;&#956;l</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">23 &#40;54&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">21 &#40;48&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 &#40;c&#233;l&#46;&#47;&#956;l&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">559&#44;9 &#40;&#177;39&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">710&#44;5 &#40;&#177;364&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD8 &#40;c&#233;l&#46;&#47;&#956;l&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">733 &#40;&#177;290&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">880&#44;6 &#40;&#177;430&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4&#47;CD8&#44; c&#233;l&#46;&#47;&#956;l &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;91 &#40;&#177;0&#44;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;96 &#40;&#177;0&#44;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CV del VIH &#40;log&#41; &#40;&#177; DS&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;11&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">38 &#40;88&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="left" valign="top">0&#44;14&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Factores de riesgo de infecci&#243;n VPH-AR en mucosa anal de MVIH&#43;&#46; An&#225;lisis bivariante y multivariante</p>"
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                            3 => "J&#46;S&#46; Chmiel"
                            4 => "J&#46;B&#46; Margolick"
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High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era

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Alta prevalencia e incidencia de lesiones precursoras de cáncer anal asociada a la infección por VPH en mujeres VIH positivas en la era tardía del TAR

High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era

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