Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain | Enfermedades Infecciosas y Microbiología Clínica

array:22 ["pii" => "S0213005X23000307" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2023.03.003" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "2708" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:251-6" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "itemSiguiente" => array:18 [ "pii" => "S0213005X22002051" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2022.09.007" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "2666" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:257-62" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Clinical and microbiological findings of recurrent Campylobacter spp. gastroenteritis in a tertiary care hospital" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "257" "paginaFinal" => "262" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Hallazgos clínicos y microbiológicos en la gastroenteritis recurrente por Campylobacter spp. en un hospital de atención terciaria" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Consuelo García-Sánchez, Julio García-Rodríguez, Guillermo Ruiz-Carrascoso" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Consuelo" "apellidos" => "García-Sánchez" ] 1 => array:2 [ "nombre" => "Julio" "apellidos" => "García-Rodríguez" ] 2 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Ruiz-Carrascoso" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X22002051?idApp=UINPBA00004N" "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X22002051/v1_202405030559/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S0213005X23000228" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2023.02.002" "estado" => "S300" "fechaPublicacion" => "2024-05-01" "aid" => "2700" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:242-50" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Characteristics of enterovirus infection associated neurologic disease in a pediatric population in Spain" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "242" "paginaFinal" => "250" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Características de la enfermedad neurológica asociada a la infección por enterovirus en una población pediátrica española" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1876 "Ancho" => 3341 "Tamanyo" => 351817 ] ] "descripcion" => array:1 [ "en" => "(a) Annual distribution of patients during the 11-year study period (n=174). (b) Distribution of cases throughout the year (n=174). (c) Isolated EV genotypes (n=69). (d) Distribution of genotypes during the study period." ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Fátima Castillo, Eulàlia Turón-Viñas, Laura Armendariz, Emma Carbonell, Nuria Rabella, Margarita del Cuerpo, Elisenda Moliner" "autores" => array:7 [ 0 => array:2 [ "nombre" => "Fátima" "apellidos" => "Castillo" ] 1 => array:2 [ "nombre" => "Eulàlia" "apellidos" => "Turón-Viñas" ] 2 => array:2 [ "nombre" => "Laura" "apellidos" => "Armendariz" ] 3 => array:2 [ "nombre" => "Emma" "apellidos" => "Carbonell" ] 4 => array:2 [ "nombre" => "Nuria" "apellidos" => "Rabella" ] 5 => array:2 [ "nombre" => "Margarita" "apellidos" => "del Cuerpo" ] 6 => array:2 [ "nombre" => "Elisenda" "apellidos" => "Moliner" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23000228?idApp=UINPBA00004N" "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X23000228/v1_202405030559/en/main.assets" ] "en" => array:20 [ "idiomaDefecto" => true "cabecera" => "Original article" "titulo" => "Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "251" "paginaFinal" => "256" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marta Fernandez-Fuertes, Juan Macias, Anaïs Corma-Gomez, Adolfo Salazar-Gonzalez, Alejandro Gonzalez-Serna, Pilar Rincon, Maria J. Arriaza-Estevez, Ana Fuentes-Lopez, Luis M. Real, Juan A. Pineda" "autores" => array:10 [ 0 => array:3 [ "nombre" => "Marta" "apellidos" => "Fernandez-Fuertes" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 1 => array:4 [ "nombre" => "Juan" "apellidos" => "Macias" "email" => array:1 [ 0 => "jmacias7@us.es" ] "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Anaïs" "apellidos" => "Corma-Gomez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 3 => array:3 [ "nombre" => "Adolfo" "apellidos" => "Salazar-Gonzalez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 4 => array:3 [ "nombre" => "Alejandro" "apellidos" => "Gonzalez-Serna" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 5 => array:3 [ "nombre" => "Pilar" "apellidos" => "Rincon" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 6 => array:3 [ "nombre" => "Maria J." "apellidos" => "Arriaza-Estevez" "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] ] ] 7 => array:3 [ "nombre" => "Ana" "apellidos" => "Fuentes-Lopez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "c" "identificador" => "aff0015" ] ] ] 8 => array:3 [ "nombre" => "Luis M." "apellidos" => "Real" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "d" "identificador" => "aff0020" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "1" "identificador" => "fn1" ] ] ] 9 => array:3 [ "nombre" => "Juan A." "apellidos" => "Pineda" "referencia" => array:4 [ 0 => array:2 [ "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "e" "identificador" => "aff0025" ] 3 => array:2 [ "etiqueta" => "1" "identificador" => "fn1" ] ] ] ] "afiliaciones" => array:5 [ 0 => array:3 [ "entidad" => "Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Department of Medicine, University of Sevilla, Sevilla, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Malaga, Malaga, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain" "etiqueta" => "e" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Baja tasa de vacunación y riesgo de incidencia de hepatitis A entre hombres que tienen sexo con hombres infectados por VIH en Sevilla, sur de España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1478 "Ancho" => 2508 "Tamanyo" => 197580 ] ] "descripcion" => array:1 [ "en" => "Biannual HAV incidence in susceptible patients (n=272)*. *Patients vaccinated against HAV during the follow-up were censored at the date of vaccination." ] ] ] "textoCompleto" => "IntroductionWHO estimates that approximately 1.5 million people become infected by hepatitis A virus (HAV) every year.<a class="elsevierStyleCrossRef" href="#bib0155">1</a> HAV is primarily spread by the fecal-oral route through person-to-person contact or by contaminated food or water. Due to an improvement of health conditions and also because of the socioeconomic development, the incidence of HAV infection is low in European countries.<a class="elsevierStyleCrossRefs" href="#bib0160">2,3</a> However, spikes in the incidence rate of HAV infection have been detected in the adult population. Epidemic outbreaks of the disease have occurred in Europe<a class="elsevierStyleCrossRefs" href="#bib0170">4–6</a> and USA<a class="elsevierStyleCrossRefs" href="#bib0185">7,8</a> mainly among men who have sex with men (MSM) infected or not with HIV.<a class="elsevierStyleCrossRefs" href="#bib0180">6,9</a>Although vaccination against HAV is an effective way to prevent individual infections and to reduce the impact of outbreaks, its recommendation for adults is not included in most of the vaccination policies in European countries and USA.<a class="elsevierStyleCrossRefs" href="#bib0200">10,11</a> Even so, when HAV vaccination is recommended in vaccination programs, it is mostly approved for high-risk groups of people, where HIV-infected patients are not included as one of them until recently only in some countries, in 2018 in the case of Spain.<a class="elsevierStyleCrossRef" href="#bib0210">12</a> For that reason, low rates of vaccination against HAV have been reported among risk groups as HIV-infected patients, MSM or injecting drugs users (IDUs).<a class="elsevierStyleCrossRefs" href="#bib0185">7,8,13</a>Incidence studies based on serology and conducted in large prospective HIV-infected cohorts are needed in order to a better estimate of the real incidence of and risk factors for HAV infection among HIV-infected patients. Most importantly, these studies could identify people vaccinated that do not develop immunological response against the virus, leaving this group of people at risk of infection. To the best of our knowledge, the information about factors associated with HAV infection come from case reports and cross-sectional studies<a class="elsevierStyleCrossRefs" href="#bib0185">7,8,13</a> with the subsequent underestimation of the real incidence of the infection.Because of this, we aimed at evaluating the incidence of and risk factors for HAV infection in HIV-infected patients in our area in recent years. We also assessed the rates of HAV vaccination in this population.MethodsStudy design and patientsThis was a prospective cohort study. The cohort includes all HIV-infected patients attending the Unit of Infectious Diseases in the Hospital Universitario Virgen de Valme from January 2008 to August 2019. Patients were seen in scheduled clinical visits at least every 6 months. At each visit, epidemiological, clinical and laboratory data were recorded. A serum sample was collected and stored in each programmed visit. All included patients had two or more frozen serum samples available collected at least 12 months apart. Individuals with only one serum sample were excluded from the study.Definitions and proceduresPatients were classified as incident HAV infection cases if they had a baseline negative serum HAV antibody test and detectable serum HAV antibodies at the end of follow-up with an antibody cut-off >20UI/mL to be considered positive titer. For incident HAV cases, the year of infection was determined by testing sera stored every year since baseline, in order to detect the year of seroconversion. Patients vaccinated against HAV during the follow-up were censored at the date of seroconversion post-vaccination.Sera remained frozen at −80°C until thawing for the determination of HAV antibodies. HAV antibodies were measured using a commercial bioluminescence immunoassay (LIAISON Anti-HAV (310170), DiaSorin S.p.A., Saluggia, Vercelli, Italy).Vaccination took place at the Unit of Preventive Medicine in our Hospital. Following the national recommendations, patients received 2 doses of the vaccine 6 months apart. Patients with only one dose were considered incomplete vaccinations.Statistical analysisFor descriptive analysis, continuous variables were expressed as median (Q1–Q3) and categorical variables as frequencies (percentage). The χ2 test or Fisher's exact test were used to compare the distribution of categorical variables. The Student's t-test or the Mann–Whitney U test were applied to compare continuous variables. Global incidence and biannual incidence were calculated along with 95% confidence interval (95% CI). Binary logistic regression models were elaborated to assess the factors independently associated with HAV seroconversion among susceptible patients who had not been vaccinated. In those analyses, variables related to this condition with a univariate p value <0.2, as well as age and sex, were included. Differences were considered significant for p values ≤0.05. The incidence of infection during outbreak periods (2009–2010 and 2017–2018) were compared with that observed in the period of lower incidence of infection detected (2013–2014) in order to find out possible different features between periods. All analyses were carried out using the SPSS software 25.0 (IBM Corporation, Somers, New York City, New York, USA).Ethical issuesThis study was designed and performed according to the Helsinki declaration and was approved by the ethics committee of the Hospital Universitario Virgen de Valme (Seville, Spain). Informed consent was obtained from all individuals.ResultsCharacteristics of the populationOf the 933 patients included in the cohort, 915 finally met the inclusion criteria. The baseline characteristics of the patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>. Most individuals showed a good immunological status (<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>). The median time of follow-up was 7.7 (3.9–9.6) years. There were 147 (16.1%) patients lost to follow-up and 73 (8%) individuals died during the study.<elsevierMultimedia ident="tbl0005"></elsevierMultimedia>Incidence of and risk factors for HAV infection and vaccinationAt baseline, 272 (30%) subjects had a negative HAV serology and 26 (9.5%) of them became infected with HAV during the study period. Of those, 18 (69.2%) were asymptomatic and 8 (30.8%) developed symptoms. Only one (12.5%) of the symptomatic patients developed a severe acute hepatitis and needed admission. All susceptible patients had a serum sample yearly until the date of seroconversion associated with infection or vaccination. The median time of follow-up among susceptible individuals was 6.2 (3.0–9.6) years. Among patients with HAV incident infection, 15 (58%) were MSM and 11 (42%) non-MSM individuals (p=0.267). Biannual incident cases among all susceptible individuals are summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>. Annual incidence was 1.54 (95% CI, 1.05–2.26) per 100 persons-year. Biannual incidence is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>. Incident cases peaked in 2009–2010 and 2017–2018 (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). MSM was de risk group more represented in the outbreaks compared with the valley period of 2013–2014 [(2009–2010: 3 (6.8%) vs. 2013–2014: 1 (1.3%), p=0.102) (2017–2018: 7 (8.0%) vs. 2013–2014: 1 (1.3%), p=0.045)].<elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia>The factors associated with incident infection among unvaccinated patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>. After multivariate analysis, adjusted by age, sex and CDC stage, MSM group and age were independently associated with incident HAV infection (<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>).<elsevierMultimedia ident="tbl0015"></elsevierMultimedia>Among 272 patients with negative baseline HAV serology, 105 (39%) were vaccinated against HAV along the study period. Out of those, 65 (61.9%) were MSM. Vaccinated patients received the first dose of vaccine a median (Q1–Q3) of 19 (7–75) months after the baseline date. Seventy-six (72.4%) individuals completed the vaccination schedule with 2 doses of the vaccine. Sixty-six (87%) of them showed seroconversion after HAV vaccination. Most patients with adequate vaccination showed persistent serum antibodies, but one (1.5%) individual showed seroreversion 4 years after successful vaccination. Among 10 (13%) non-responders to adequate vaccination, there were three (30%) patients who seroconverted five to nine years after vaccination (<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>) and they were considered as infections. Among 28 (27%) patients with an incomplete HAV vaccination schedule, 11 (39%) did not show anti-HAV seroconversion after the first and only vaccine dose. One (9.1%) of them showed anti-HAV serocoversion five years after vaccination with only one dose and he was also considered as an infection. The overall incidence of HAV infection for vaccinated patients was 3.8% (4 out of 105) with all of them developing asymptomatic infections.<elsevierMultimedia ident="tbl0020"></elsevierMultimedia>DiscussionWe found that the incidence of HAV infection, confirmed by serological testing, among a well-controlled HIV-infected cohort remains low and steady, with periodical outbreaks involving mainly MSM. The fact that a significant proportion of these patients remain susceptible to HAV infection leads to these outbreaks. Insufficient vaccine coverage and limited response to vaccination underlies the elevated susceptibility to HAV infection in this population. In addition, these results prove that patients not responding to anti-HAV vaccination continue at risk of infection.Our outbreaks observations are consistent with previous data in different areas in Europe mainly observed in unvaccinated MSM, regardless whether they were infected <a class="elsevierStyleCrossRef" href="#bib0195">9</a> or not by HIV.<a class="elsevierStyleCrossRefs" href="#bib0175">5,14</a> Most incident HAV infections in our study were detected in MSM, as in previous reports.<a class="elsevierStyleCrossRefs" href="#bib0170">4–9,13,15</a> During our period of study two outbreaks were reported in different countries in 2008–2009<a class="elsevierStyleCrossRef" href="#bib0230">16</a> and in 2016–2017.<a class="elsevierStyleCrossRefs" href="#bib0175">5,7,9,16</a> Both international outbreaks overlap in time with the outbreaks observed in our study pointing out that our serological study is in line with those surveys in the rest of Europe and USA.In agreement with previous observations, we found a significant rate of HAV vaccine failure. Immunosuppression has been reported to influence HAV vaccine response in HIV infection. CD4 cell counts lower than 200cells/mcL and low CD4/CD8 ratio have been associated with poorer response.<a class="elsevierStyleCrossRefs" href="#bib0235">17,18</a> For HIV viremia, there are contradictory results, with studies showing an association of higher levels of viremia with lack of seroconversion after vaccination,<a class="elsevierStyleCrossRefs" href="#bib0245">19,20</a> and other studies reporting no relationship with response to vaccination.<a class="elsevierStyleCrossRefs" href="#bib0235">17,21</a> In any case, lower protection rates following vaccination are observed in HIV infection,<a class="elsevierStyleCrossRefs" href="#bib0260">22,23</a> where also specific antibodies are lower among HIV positive individuals compared with the general population.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> Although it is not clear whether those individuals should undergo HAV revaccination, the loss of immunity may be addressed using additional boosters.<a class="elsevierStyleCrossRefs" href="#bib0275">25–29</a> Moreover, high seroconversion rates in HIV-infected population with one-dose of HAV inactivated vaccine after losing anti-HAV following primary vaccination have been reported.<a class="elsevierStyleCrossRef" href="#bib0285">27</a> Thus, follow-up monitoring of serological response after vaccination to evaluate the need of additional booster vaccination among HIV-infected population should be implemented.After adequate HAV vaccination, the majority of patients with initial response to vaccination showed long-term persistence of antibodies. Only one patient lost anti-HAV antibodies four years after vaccination. This potential loss of response over time indicates that periodic reassessment HAV serology is needed for HIV-infected patients. However, the more frequent reason for lack of seroprotection among vaccinated patients was an incomplete schedule of vaccination. Nearly one third of the individuals who started the vaccination program did not receive the second dose of vaccine. Potential explanations for this failure to complete the vaccination program include the loss of adherence to the program follow-up. The tertiary care centered vaccination, as opposed to administration in primary care settings, is another likely barrier together with the fact that HAV vaccination was not recommended until 2018 in our country for HIV positive patients.Asymptomatic infections are the common presentation in children. On the contrary, approximately 30% of patients older than 6 years develop symptoms.<a class="elsevierStyleCrossRef" href="#bib0270">24</a> Regarding HIV-infected patients, the information is scarce about the possible differences with HIV-uninfected individuals. A small study suggested no differences in the frequency or severity of symptoms.<a class="elsevierStyleCrossRef" href="#bib0300">30</a> In the present study, we found that one third of the patients with HAV seroconversion developed symptoms, in line with the clinical picture in the general population. Interestingly, patients with complete or incomplete vaccination who were infected by HAV did not develop symptoms. This may indicate that some low level of immunity among vaccinated HIV-infected patients, below the threshold of antibody titer considered to indicate seroprotection, could induce a milder hepatitis A course among.Our study presents several limitations. First, this was a cohort study based on the analysis of stored sera during a long period of observation. Should sera had been inconsistently gathered, the estimations of incidence would have been inaccurate. However, we could evaluate yearly serum samples of 94% patients in the cohort. This is a strength of the study. Second, detailed sexual habits were not assessed, which precludes an evaluation of sexual risk factors associated with HAV infection. Third, 6.7% vaccinated individuals lacked serological follow-up. The prolonged period of follow up and the annual serology performed within a cohort of HIV-infected patients are strengths of this study.In conclusion, insufficient immunization against HAV in HIV-infected people leads to periodic hepatitis A outbreaks. Importantly, patients without response to HAV vaccination are at risk of incident infection. Strategies to implement widespread HAV vaccination are needed for HIV-infected people and particularly MSM HIV-infected patients.Data availabilityThe datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.Author contributionsJuan Macias (J.M.) and Marta Fernandez-Fuertes (M.F.F.) had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.Study concept and design: Juan A Pineda (J.A.P.) and Luis M. Real (L.M.R.).Acquisition, analysis, or interpretation of data: J.M., M.F.F., Anaïs Corma-Gomez (A.C.G.), Adolfo de Salazar (A.S.).Statistical analysis: J.A.P. and L.M.R.Drafting of the manuscript: J.M. and M.F.F.Critical revision of the manuscript for important intellectual content: J.M., M.F.F., A.C.G., A.S., Alejandro González-Serna (A.G.S.), Pilar RINCON (P.R.), Maria J. Arriaza-Estevez (M.J.A.E.), Ana Fuentes-Lopez (A.F.L.), L.M.R., and J.A.P.Obtained funding: J.M., A.C.G, A.G.S. and J.A.P.Study supervision: J.A.P. and L.M.R.FundingThis work was supported in part by the Instituto de Salud Carlos III (Project’PI16/01443’), integrated in the national I+D+i 2013-2016 and co-funded by the European Union (ERDF/ESF,“Investing in your future”), by the Spanish Network for AIDS investigation (RIS)(<a href="http://www.red.es/redes/inicio">http://www.red.es/redes/inicio</a>) (RD16/0025/0010), as a part of the Nacional I+D+I, ISCIII Subdirección General de Evaluación and the European Fund for Development of Regions (FEDER). This research was also supported by CIBER -Consorcio Centro de Investigación Biomédica en Red-(CB 2021), Instituto de Salud Carlos III, Ministerio de Ciencia e Innovación and Unión Europea-NextGenerationEU. JAP has received a research extension grant from the Programa de Intensificación de la Actividad de Investigación del Servicio Nacional de Salud Carlos III (I3SNS). JM has received a research extension grant from Consejería de Salud, Junta de Andalucía (A1-0060-2021). A.C-G has received a research extension grant Acción B, Acción para el Refuerzo de la Actividad Investigadora en las Unidades Clínicas del Servicio Andaluz de Salud 2021, Clínicos Investigadores (grant number B-0061-2021). This work was supported by the Ministry of Science, Innovation and Universities of Spain for A.G.-S who is recipient of a Miguel Servet Research Contract (CP18/00146), co-financed by the FSE’El Fondo Social Europeo invierte en tu futuro’.Conflict of interestsJM has been an investigator in clinical trials supported by Bristol-Myers Squibb, Gilead and Merck Sharp & Dome. He has received lectures fees from Gilead, Bristol-Myers Squibb, and Merck Sharp & Dome, and consulting fees from Bristol Myers-Squibb, Gilead, and Merck Sharp & Dome. JAP reports having received consulting fees from Bristol-Myers Squibb, Abbvie, ViiV Healthcare, Gilead, Merck Sharp & Dome, and Janssen Cilag. He has received research support from Bristol-Myers Squibb, ViiV Healthcare, Abbvie, Merck Sharp & Dome, Janssen Cilag and Gilead and has received lecture fees from Abbvie, Bristol-Myers Squibb, ViiV Healthcare, Merck Sharp & Dome, Abbvie, Janssen Cilag, and Gilead. ACG has received lecture fees from Gilead, Merck Sharp & Dome and Abbvie. The remaining authors report no conflict of interest." "textoCompletoSecciones" => array:1 [ "secciones" => array:13 [ 0 => array:3 [ "identificador" => "xres2138628" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1815772" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2138629" "titulo" => "Resumen" "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1815773" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:3 [ "identificador" => "sec0010" "titulo" => "Methods" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0015" "titulo" => "Study design and patients" ] 1 => array:2 [ "identificador" => "sec0020" "titulo" => "Definitions and procedures" ] 2 => array:2 [ "identificador" => "sec0025" "titulo" => "Statistical analysis" ] 3 => array:2 [ "identificador" => "sec0030" "titulo" => "Ethical issues" ] ] ] 6 => array:3 [ "identificador" => "sec0035" "titulo" => "Results" "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0040" "titulo" => "Characteristics of the population" ] 1 => array:2 [ "identificador" => "sec0045" "titulo" => "Incidence of and risk factors for HAV infection and vaccination" ] ] ] 7 => array:2 [ "identificador" => "sec0050" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0055" "titulo" => "Data availability" ] 9 => array:2 [ "identificador" => "sec0060" "titulo" => "Author contributions" ] 10 => array:2 [ "identificador" => "sec0070" "titulo" => "Funding" ] 11 => array:2 [ "identificador" => "sec0065" "titulo" => "Conflict of interests" ] 12 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-02-09" "fechaAceptado" => "2023-03-08" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1815772" "palabras" => array:4 [ 0 => "HIV" 1 => "Hepatitis A" 2 => "Vaccination" 3 => "Incidence" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1815773" "palabras" => array:4 [ 0 => "VIH" 1 => "Hepatitis A" 2 => "Vacunación" 3 => "Incidencia" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "BackgroundPeriodic outbreaks of hepatitis A (HAV) infection in men who have sex with men (MSM) have been reported. Low vaccination uptake in HIV-infected individuals could drive new outbreaks. We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV (PLWH) in our area. We also assessed the rates of HAV vaccination. MethodsThis was a prospective cohort study. 915 patients were included, 272 (30%) of them were anti-HAV seronegative at baseline. ResultsTwenty-six (9.6%) susceptible individuals became infected. Incident cases peaked in 2009–2010 and 2017–2018. Incident HAV infection was independently associated with MSM [adjusted odds ratio (95% confidence ratio): 4.39 (1.35–14.27), p=0.014]. One hundred and five (38.6%) HAV seronegative patients were vaccinated, 21 (20%) of them did not respond, and one (1%) patient lost immunity against HAV. Four (29%) non-responders to vaccination showed incident HAV 5–9 years afterwards. ConclusionsThe incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable, with intermittent outbreaks involving mainly non-immunized MSM. A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination. Importantly, patients not responding to HAV vaccination continue at risk of infection." "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Background" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "IntroducciónSe han notificado brotes periódicos de infección por hepatitisA (VHA) en hombres que practican sexo con hombres (HSH). La baja tasa de vacunación en personas infectadas por el VIH podría dar lugar a nuevos brotes. ObjetivoEvaluar la incidencia y los factores de riesgo de la infección por VHA en personas que viven con el VIH (PVVS) en nuestra área. Se evaluaron también las tasas de vacunación frente al VHA. MétodosEstudio de cohortes prospectivo en el que se incluyeron 915 pacientes, 272 (30%) de los cuales eran seronegativos frente al VHA al inicio del estudio. ResultadosVeintiséis (9,6%) individuos susceptibles se infectaron. Los casos incidentes alcanzaron su punto máximo en 2009-2010 y en 2017-2018. La infección incidente por VHA se asoció de forma independiente con HSH (odds ratio ajustada [índice de confianza del 95%]: 4,39 [1,35-14,27], p=0,014). Ciento cinco (38,6%) pacientes seronegativos frente al VHA fueron vacunados, 21 (20%) de ellos no respondieron y un paciente (1%) perdió la inmunidad frente al VHA. Cuatro (29%) pacientes que no respondieron a la vacunación presentaron infección por el VHA entre 5 y 9años después. ConclusionesLa incidencia de la infección por VHA en una cohorte de PVVS bien controlada sigue siendo baja y estable, con brotes intermitentes que afectan principalmente a HSH no inmunizados. Una proporción significativa de PVVS sigue siendo susceptible a la infección por VHA debido a la insuficiente vacunación y a la respuesta limitada a la misma. Es importante destacar que los pacientes que no responden a la vacunación frente al VHA siguen estando en riesgo de infección." "secciones" => array:5 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Objetivo" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Métodos" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Resultados" ] 4 => array:2 [ "identificador" => "abst0045" "titulo" => "Conclusiones" ] ] ] ] "NotaPie" => array:1 [ 0 => array:3 [ "etiqueta" => "1" "nota" => "Equal contribution." "identificador" => "fn1" ] ] "multimedia" => array:5 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1478 "Ancho" => 2508 "Tamanyo" => 197580 ] ] "descripcion" => array:1 [ "en" => "Biannual HAV incidence in susceptible patients (n=272)*. *Patients vaccinated against HAV during the follow-up were censored at the date of vaccination." ] ] 1 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at1" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Abbreviations: PWID: people who inject drugs; MSM: men who have sex with men; AIDS: acquired immunodeficiency syndrome; HCV: hepatitis C virus; Ab: antibody; HBsAg: surface antigen of the hepatitis B virus." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male sex, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">743 (81.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age,years<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 (47–57) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HIV transmission, n (%)</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">PWID \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">470 (51.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">230 (25.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Heterosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">179 (19.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Other \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">34 (3.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">AIDS, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">256 (28.0) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Undetectable plasma HIVRNA<a class="elsevierStyleCrossRef" href="#tblfn0010">b</a>(%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">582 (63.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CD4+cell count/μl<a class="elsevierStyleCrossRef" href="#tblfn0005">a</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">495 (304–687) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive anti-HCV Ab, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">523 (57.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">HBsAg, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">31 (3.4) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detectable plasma HCV RNA, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">368 (40.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Positive anti-HAV, n (%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">637 (69.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3525387.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "a" "nota" => "Median (Q1–Q3)." ] 1 => array:3 [ "identificador" => "tblfn0010" "etiqueta" => "b" "nota" => "Less than 20copies/μl." ] ] ] "descripcion" => array:1 [ "en" => "Baseline characteristics of the study population (n=915)." ] ] 2 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at2" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "Abbreviations: CI: confidence interval." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of cases \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI 95% \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2009–2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.83 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.40–1.74 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2011–2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.45 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.17–1.20 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2013–2014 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.11 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.02–0.79 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2015–2016 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.22 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.06–0.90 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2017–2018 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.40 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.80–2.47 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2019 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3525389.png" ] ] ] ] "descripcion" => array:1 [ "en" => "Biannual HAV incidence (100 persons-year)." ] ] 3 => array:8 [ "identificador" => "tbl0015" "etiqueta" => "Table 3" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at3" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Abbreviations: MSM: men who have sex with men; CDC stage: centers of disease control and prevention stage; AOR: adjusted odd ratio." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameter \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">N \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency of HAV infectionN (%) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p univariate \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AOR (95% CI) \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p multivariate \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Sex</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 (4.7%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2.99 (0.61–14.73) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.178 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (19.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Age<a class="elsevierStyleCrossRef" href="#tblfn0015">a</a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">80 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">14 (17.5%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.509 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1.08 (1.02–1.14) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">≥46 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">87 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (13.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.008 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Risk group</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (23.8%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.022 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">4.39 (1.35–14.27) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.014 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">No MSM \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">104 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (10.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Plasma HIVRNA<a class="elsevierStyleCrossRef" href="#tblfn0020">b</a></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Detectable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">114 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (14.9%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.731 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Undetectable \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">53 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (17%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CDC stage</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">C \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">36 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 (8.3%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.170 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.29 (0.07–1.28) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.109 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">A or B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">131 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">23 (17.6%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " colspan="6" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">CD4 cell count/ml</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">49 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 (18.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">0.603 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">>350 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">118 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="char" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (14.4%) \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3525388.png" ] ] ] "notaPie" => array:2 [ 0 => array:3 [ "identificador" => "tblfn0015" "etiqueta" => "a" "nota" => "Entered as a continuous variable in the multivariate analysis." ] 1 => array:3 [ "identificador" => "tblfn0020" "etiqueta" => "b" "nota" => "Less than 20copies/μl." ] ] ] "descripcion" => array:1 [ "en" => "Univariate and multivariate analysis of risk factors associated with incident HAV infection among unvaccinated individuals (n=167)." ] ] 4 => array:8 [ "identificador" => "tbl0020" "etiqueta" => "Table 4" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at4" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:3 [ "leyenda" => "Patient 4 was incompletely vaccinated, received only the first dose." "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 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="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">First dose date \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Second dose date \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time between the last dose and the date of seroconversion<a class="elsevierStyleCrossRef" href="#tblfn0025">a</a> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seroconversion year \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 1 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">June 22nd, 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">December 21st, 2011 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">April, 2017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 2 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">May 27th, 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">October 21st, 2008 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">9 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">September, 2017 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 3 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">January 20th, 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">November 22nd, 2010 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">8 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">June, 2018 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">Patient 4 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">March 22nd, 2012 \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">– \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 years \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">March, 2017 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab3525390.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0025" "etiqueta" => "a" "nota" => "All patients showed negative anti-HAV serology score yearly since the last dose of HAV vaccine until the date of seroconversion." ] ] ] "descripcion" => array:1 [ "en" => "Characteristics of vaccinated individuals who became infected with HAV (n=4)." ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:30 [ 0 => array:3 [ "identificador" => "bib0155" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "World Health Organization. Global hepatitis report, 2017. Global Hepatitis Programme. WHO; 2017 [accesed Dec 5 2022]. <a target="_blank" href="http://who.int/publications/i/item/global-hepatitis-report-2017">http://who.int/publications/i/item/global-hepatitis-report-2017</a>." ] ] ] 1 => array:3 [ "identificador" => "bib0160" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic area: a systematic review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Carrillo-Santisteve" 1 => "L. Tavoschi" 2 => "E. Severi" 3 => "S. Bonfigli" 4 => "M. Edelstein" 5 => "E. Byström" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Lancet Infect Dis" "fecha" => "2017" "volumen" => "17" "paginaInicial" => "306" "paginaFinal" => "319" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0165" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Globalization and the changing epidemiology of hepatitis A virus" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "K.H. Jacobsen" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:3 [ "tituloSerie" => "Cold Spring Harb Perspect Med" "fecha" => "2018" "volumen" => "8" ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0170" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Monophyletic outbreak of hepatitis A involving HIV-infected men who have sex with men, Rome, Italy 2008–2009" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "L. Bordi" 1 => "G. Rozera" 2 => "P. Scognamiglio" 3 => "C. Minosse" 4 => "M. Loffredo" 5 => "A. Antinori" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "J Clin Virol" "fecha" => "2012" "volumen" => "54" "paginaInicial" => "26" "paginaFinal" => "29" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0175" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis A outbreak among men who have sex with men (MSM) predominantly linked with the EuroPride, the Netherlands, July 2016 to February 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.S. Freidl" 1 => "G.J. Sonder" 2 => "L.P. Bovée" 3 => "I.H. Friesema" 4 => "G.G. van RIjckevorsel" 5 => "W.L. Ruijs" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eurosurveillance" "fecha" => "2017" "volumen" => "22" "paginaInicial" => "1" "paginaFinal" => "5" ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0180" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of hepatitis A associated with men who have sex with men (MSM), England, July 2016 to January 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Beebeejaun" 1 => "S. Degala" 2 => "K. Balogun" 3 => "I. Simms" 4 => "S.C. Woodhall" 5 => "E. Heinsbroek" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eurosurveillance" "fecha" => "2017" "volumen" => "22" "paginaInicial" => "1" "paginaFinal" => "6" ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0185" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis A virus immunity and vaccination among at-risk persons receiving HIV medical care" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "N.P. DeGroote" 1 => "C.L. Mattson" 2 => "Y. Tie" 3 => "J.T. Brooks" 4 => "S. Garg" 5 => "J. Weiser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.pmedr.2018.06.006" "Revista" => array:6 [ "tituloSerie" => "Prev Med Rep" "fecha" => "2018" "volumen" => "11" "paginaInicial" => "139" "paginaFinal" => "144" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30003012" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0190" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Susceptibility to hepatitis A virus infection in the United States, 2007–2016" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Yin" 1 => "L. Barker" 2 => "K.N. Ly" 3 => "G. Kilmer" 4 => "M.A. Foster" 5 => "J. Drobeniuc" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2020" "volumen" => "71" "paginaInicial" => "571" "paginaFinal" => "579" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0195" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis a outbreak disproportionately affecting men who have sex with men (MSM) in the European union and European economic area, June 2016 to May 2017" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "P. Ndumbi" 1 => "G.S. Freidl" 2 => "C.J. Williams" 3 => "O. Mardh" 4 => "C. Varela" 5 => "A. Avellon" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Eurosurveillance" "fecha" => "2018" "volumen" => "23" "paginaInicial" => "1" "paginaFinal" => "12" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0200" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Vaccination programs for adults in Europe, 2019" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "D.C. Cassimos" 1 => "E. Effraimidou" 2 => "S. Medic" 3 => "T. Konstantinidis" 4 => "M. Theodoridou" 5 => "H.C. Maltezou" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/s41541-022-00593-8" "Revista" => array:6 [ "tituloSerie" => "Vaccines" "fecha" => "2020" "volumen" => "8" "paginaInicial" => "1" "paginaFinal" => "15" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36650164" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0205" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Center of Disease Control and Prevention. Recommended adult immunization schedule CDC 2019 guidelines; 2020 [accesed Jan 8 2023]. <a target="_blank" href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a6.htm">http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a6.htm</a>." ] ] ] 11 => array:3 [ "identificador" => "bib0210" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Comisión de Salud Pública del Consejo Interterritorial del Sistema Nacional de Salud. Ministerio de Sanidad, Consumo y Bienestar Social. Ponencia de Programa y Registro de Vacunaciones. Vacunación en grupos de riesgo de todas las edades y en determinadas situaciones; 2018, pp. 1–165." ] ] ] 12 => array:3 [ "identificador" => "bib0215" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiology of hepatitis A in Greece in the last decade. Management of reported cases and outbreaks and lessons learned" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K. Mellou" 1 => "A. Chrysostomou" 2 => "T. Sideroglou" 3 => "M. Kyritsi" 4 => "T. Georgakopoulou" 5 => "S. Tsiodras" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1017/S0950268820002721" "Revista" => array:6 [ "tituloSerie" => "Epidemiol Infect" "fecha" => "2020" "volumen" => "148" "paginaInicial" => "1" "paginaFinal" => "6" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33153501" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0220" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new pattern in hepatitis A virus infection in an urban population" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "H. Martínez Lozano" 1 => "A. Conthe Alonso" 2 => "R. Bañares" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.17235/reed.2020.6526/2019" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2020" "volumen" => "112" "paginaInicial" => "178" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32081016" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0225" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Trends in condom use among MSM in the United States: The role of antiretroviral therapy and seroadaptive strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Paz-Bailey" 1 => "M.C. Mendoza" 2 => "T. Finlayson" 3 => "C. Wejnert" 4 => "B. Le" 5 => "C. Rose" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAD.0000000000001139" "Revista" => array:6 [ "tituloSerie" => "AIDS" "fecha" => "2016" "volumen" => "30" "paginaInicial" => "1985" "paginaFinal" => "1990" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27149088" "web" => "Medline" ] ] ] ] ] ] ] ] 15 => array:3 [ "identificador" => "bib0230" "etiqueta" => "16" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outbreak of hepatitis A among men who have sex with men in Barcelona, Spain, September 2008–March 2009" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Tortajada" 1 => "P.G. de Olalla" 2 => "R.M. Pinto" 3 => "A. Bosch" 4 => "J. Caylà" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Euro Surveill" "fecha" => "2009" "volumen" => "14" "paginaInicial" => "20" "paginaFinal" => "22" ] ] ] ] ] ] 16 => array:3 [ "identificador" => "bib0235" "etiqueta" => "17" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immune response to hepatitis A vaccination in HIV-infected men in Greece" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Kourkounti" 1 => "N. Mavrianou" 2 => "A.V. Paparizos" 3 => "K. Kyriakis" 4 => "M. Hatzivassiliou" 5 => "T. Kordosis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1258/ijsa.2011.011297" "Revista" => array:6 [ "tituloSerie" => "Int J STD AIDS" "fecha" => "2012" "volumen" => "23" "paginaInicial" => "464" "paginaFinal" => "467" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22843998" "web" => "Medline" ] ] ] ] ] ] ] ] 17 => array:3 [ "identificador" => "bib0240" "etiqueta" => "18" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A case of acute hepatitis A infection in an HIV-positive patient despite complete hepatitis A vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "C. Fritzsche" 1 => "M. Loebermann" 2 => "E.C. Reisinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s15010-018-1129-1" "Revista" => array:6 [ "tituloSerie" => "Infection" "fecha" => "2018" "volumen" => "46" "paginaInicial" => "565" "paginaFinal" => "567" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29542052" "web" => "Medline" ] ] ] ] ] ] ] ] 18 => array:3 [ "identificador" => "bib0245" "etiqueta" => "19" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Predictors of immunity after hepatitis a vaccination in HIV-infected persons" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "E.T. Overton" 1 => "D. Nurutdinova" 2 => "S. Sungkanuparph" 3 => "W. Seyfried" 4 => "R.K. Groger" 5 => "W.G. Powderly" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1365-2893.2006.00822.x" "Revista" => array:6 [ "tituloSerie" => "J Viral Hepat" "fecha" => "2007" "volumen" => "14" "paginaInicial" => "189" "paginaFinal" => "193" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17305885" "web" => "Medline" ] ] ] ] ] ] ] ] 19 => array:3 [ "identificador" => "bib0250" "etiqueta" => "20" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term durability of immune responses after hepatitis A vaccination among HIV-infected adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N.F. Crum-Cianflone" 1 => "K. Wilkins" 2 => "A.W. Lee" 3 => "A. Grosso" 4 => "M.L. Landrum" 5 => "A. Weintrob" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/infdis/jir180" "Revista" => array:6 [ "tituloSerie" => "J Infect Dis" "fecha" => "2011" "volumen" => "203" "paginaInicial" => "1815" "paginaFinal" => "1823" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21606540" "web" => "Medline" ] ] ] ] ] ] ] ] 20 => array:3 [ "identificador" => "bib0255" "etiqueta" => "21" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immune response to hepatitis A vaccine in patients with HIV" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "C. Fritzsche" 1 => "L. Bergmann" 2 => "M. Loebermann" 3 => "A. Glass" 4 => "E.C. Reisinger" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.vaccine.2019.02.064" "Revista" => array:6 [ "tituloSerie" => "Vaccine" "fecha" => "2019" "volumen" => "37" "paginaInicial" => "2278" "paginaFinal" => "2283" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30890384" "web" => "Medline" ] ] ] ] ] ] ] ] 21 => array:3 [ "identificador" => "bib0260" "etiqueta" => "22" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis B and A vaccination in HIV-infected adults: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "G. Mena" 1 => "A.L. García-Basteiro" 2 => "J.M. Bayas" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hum Vaccines Immunother" "fecha" => "2015" "volumen" => "11" "paginaInicial" => "2582" "paginaFinal" => "2598" ] ] ] ] ] ] 22 => array:3 [ "identificador" => "bib0265" "etiqueta" => "23" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis A vaccine immunogenicity in patients using immunosuppressive drugs: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "H.M. Garcia Garrido" 1 => "A.M. Veurink" 2 => "M. Leeflang" 3 => "R. Spijker" 4 => "A. Goorhuis" 5 => "M.P. Grobusch" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.tmaid.2019.101479" "Revista" => array:5 [ "tituloSerie" => "Travel Med Infect Dis" "fecha" => "2019" "volumen" => "32" "paginaInicial" => "101479" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31521804" "web" => "Medline" ] ] ] ] ] ] ] ] 23 => array:3 [ "identificador" => "bib0270" "etiqueta" => "24" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients: a review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.Y. Lin" 1 => "G.J. Chen" 2 => "Y.L. Lee" 3 => "Y.C. Huang" 4 => "A. Cheng" 5 => "H.Y. Sun" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "World J Gastroenterol" "fecha" => "2017" "volumen" => "23" "paginaInicial" => "3589" "paginaFinal" => "3606" "itemHostRev" => array:3 [ "pii" => "S0049017220302109" "estado" => "S300" "issn" => "00490172" ] ] ] ] ] ] ] 24 => array:3 [ "identificador" => "bib0275" "etiqueta" => "25" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term durability of responses to 2 or 3 doses of hepatitis a vaccination in human immunodeficiency virus-positive adults on antiretroviral therapy" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Cheng" 1 => "S.Y. Chang" 2 => "H.Y. Sun" 3 => "M.S. Tsai" 4 => "W.C. Liu" 5 => "Y.C. Su" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1093/infdis/jiw605" "Revista" => array:7 [ "tituloSerie" => "J Infect Dis" "fecha" => "2017" "volumen" => "215" "paginaInicial" => "606" "paginaFinal" => "613" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28011921" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S2213260020300369" "estado" => "S300" "issn" => "22132600" ] ] ] ] ] ] ] 25 => array:3 [ "identificador" => "bib0280" "etiqueta" => "26" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Immunological efficacy of a three-dose schedule of hepatitis A vaccine in HIV-infected adults: HEPAVAC study" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "O. Launay" 1 => "S. Grabar" 2 => "E. Gordien" 3 => "C. Desaint" 4 => "D. Jegou" 5 => "S. Abad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAI.0b013e318183a9c0" "Revista" => array:6 [ "tituloSerie" => "J Acquir Immune Defic Syndr" "fecha" => "2008" "volumen" => "49" "paginaInicial" => "272" "paginaFinal" => "275" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18845961" "web" => "Medline" ] ] ] ] ] ] ] ] 26 => array:3 [ "identificador" => "bib0285" "etiqueta" => "27" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Serological responses to revaccination with hepatitis A virus (HAV) vaccines among HIV-positive individuals whose anti-HAV antibody waned after primary vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.J. Chen" 1 => "H.Y. Sun" 2 => "K.Y. Lin" 3 => "A. Cheng" 4 => "Y.C. Huang" 5 => "S.M. Hsieh" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/liv.13665" "Revista" => array:7 [ "tituloSerie" => "Liver Int" "fecha" => "2018" "volumen" => "38" "paginaInicial" => "1198" "paginaFinal" => "1205" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29240985" "web" => "Medline" ] ] "itemHostRev" => array:3 [ "pii" => "S0140673616002324" "estado" => "S300" "issn" => "01406736" ] ] ] ] ] ] ] 27 => array:3 [ "identificador" => "bib0290" "etiqueta" => "28" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatitis A vaccination" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "L. Zhang" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Hum Vaccines Immunother" "fecha" => "2020" "volumen" => "16" "paginaInicial" => "1" "paginaFinal" => "9" ] ] ] ] ] ] 28 => array:3 [ "identificador" => "bib0295" "etiqueta" => "29" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Early seroreversion after 2 doses of hepatitis A vaccination in human immunodeficiency virus – positive patients: incidence and associated factors" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S.H. Huang" 1 => "C.H. Huang" 2 => "N.C. Wang" 3 => "T.C. Chen" 4 => "Y.T. Lee" 5 => "S.P. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/hep.30495" "Revista" => array:6 [ "tituloSerie" => "Hepatology" "fecha" => "2019" "volumen" => "70" "paginaInicial" => "465" "paginaFinal" => "475" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30614542" "web" => "Medline" ] ] ] ] ] ] ] ] 29 => array:3 [ "identificador" => "bib0300" "etiqueta" => "30" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Influence of human immunodeficiency virus type 1 infection on acute hepatitis A virus infection" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Ida" 1 => "N. Tachikawa" 2 => "A. Nakajima" 3 => "D. Manabu" 4 => "Y. Michitami" 5 => "K. Yoshimi" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1086/338152" "Revista" => array:6 [ "tituloSerie" => "Clin Infect Dis" "fecha" => "2002" "volumen" => "34" "paginaInicial" => "379" "paginaFinal" => "385" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11774086" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X23000307/v1_202405030559/en/main.assets" "Apartado" => array:4 [ "identificador" => "8591" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Originales" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000004200000005/v1_202405030559/S0213005X23000307/v1_202405030559/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23000307?idApp=UINPBA00004N"]

Statistics

Original article

Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville, Southern Spain

Baja tasa de vacunación y riesgo de incidencia de hepatitis A entre hombres que tienen sexo con hombres infectados por VIH en Sevilla, sur de España

Marta Fernandez-Fuertesa,e, Juan Maciasa,b,e,

Corresponding author

jmacias7@us.es

Corresponding author.

, Anaïs Corma-Gomeza,e, Adolfo Salazar-Gonzalezc, Alejandro Gonzalez-Sernaa,e, Pilar Rincona,e, Maria J. Arriaza-Esteveza,e, Ana Fuentes-Lopezc, Luis M. Reala,d,e,1, Juan A. Pinedaa,b,e,1

a Institute of Biomedicine of Seville (IBiS), Hospital Universitario Virgen de Valme, Sevilla, Spain

b Department of Medicine, University of Sevilla, Sevilla, Spain

c Microbiology Service, Hospital Universitario San Cecilio, Granada, Spain

d Department of Surgery, Biochemistry and Immunology, School of Medicine, University of Malaga, Malaga, Spain

e CIBERINFEC, Instituto de Salud Carlos III, Madrid, Spain

Read

119

Times
was read the article

Total PDF

Total HTML

Share statistics

 array:22 [
  "pii" => "S0213005X23000307"
  "issn" => "0213005X"
  "doi" => "10.1016/j.eimc.2023.03.003"
  "estado" => "S300"
  "fechaPublicacion" => "2024-05-01"
  "aid" => "2708"
  "copyrightAnyo" => "2023"
  "documento" => "article"
  "crossmark" => 1
  "subdocumento" => "fla"
  "cita" => "Enferm Infecc Microbiol Clin. 2024;42:251-6"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "itemSiguiente" => array:18 [
    "pii" => "S0213005X22002051"
    "issn" => "0213005X"
    "doi" => "10.1016/j.eimc.2022.09.007"
    "estado" => "S300"
    "fechaPublicacion" => "2024-05-01"
    "aid" => "2666"
    "copyright" => "Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Infecc Microbiol Clin. 2024;42:257-62"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Clinical and microbiological findings of recurrent <span class="elsevierStyleItalic">Campylobacter</span> spp&#46; gastroenteritis in a tertiary care hospital"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "257"
          "paginaFinal" => "262"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hallazgos cl&#237;nicos y microbiol&#243;gicos en la gastroenteritis recurrente por <span class="elsevierStyleItalic">Campylobacter</span> spp&#46; en un hospital de atenci&#243;n terciaria"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Consuelo Garc&#237;a-S&#225;nchez, Julio Garc&#237;a-Rodr&#237;guez, Guillermo Ruiz-Carrascoso"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Consuelo"
              "apellidos" => "Garc&#237;a-S&#225;nchez"
            ]
            1 => array:2 [
              "nombre" => "Julio"
              "apellidos" => "Garc&#237;a-Rodr&#237;guez"
            ]
            2 => array:2 [
              "nombre" => "Guillermo"
              "apellidos" => "Ruiz-Carrascoso"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X22002051?idApp=UINPBA00004N"
    "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X22002051/v1_202405030559/en/main.assets"
  ]
  "itemAnterior" => array:18 [
    "pii" => "S0213005X23000228"
    "issn" => "0213005X"
    "doi" => "10.1016/j.eimc.2023.02.002"
    "estado" => "S300"
    "fechaPublicacion" => "2024-05-01"
    "aid" => "2700"
    "copyright" => "Sociedad Espa&#241;ola de Enfermedades Infecciosas y Microbiolog&#237;a Cl&#237;nica"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "fla"
    "cita" => "Enferm Infecc Microbiol Clin. 2024;42:242-50"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:13 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
      "titulo" => "Characteristics of enterovirus infection associated neurologic disease in a pediatric population in Spain"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => array:2 [
        0 => "en"
        1 => "es"
      ]
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "242"
          "paginaFinal" => "250"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Caracter&#237;sticas de la enfermedad neurol&#243;gica asociada a la infecci&#243;n por enterovirus en una poblaci&#243;n pedi&#225;trica espa&#241;ola"
        ]
      ]
      "contieneResumen" => array:2 [
        "en" => true
        "es" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0005"
          "etiqueta" => "Fig&#46; 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1876
              "Ancho" => 3341
              "Tamanyo" => 351817
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">&#40;a&#41; Annual distribution of patients during the 11-year study period &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>174&#41;&#46; &#40;b&#41; Distribution of cases throughout the year &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>174&#41;&#46; &#40;c&#41; Isolated EV genotypes &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>69&#41;&#46; &#40;d&#41; Distribution of genotypes during the study period&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "F&#225;tima Castillo, Eul&#224;lia Tur&#243;n-Vi&#241;as, Laura Armendariz, Emma Carbonell, Nuria Rabella, Margarita del Cuerpo, Elisenda Moliner"
          "autores" => array:7 [
            0 => array:2 [
              "nombre" => "F&#225;tima"
              "apellidos" => "Castillo"
            ]
            1 => array:2 [
              "nombre" => "Eul&#224;lia"
              "apellidos" => "Tur&#243;n-Vi&#241;as"
            ]
            2 => array:2 [
              "nombre" => "Laura"
              "apellidos" => "Armendariz"
            ]
            3 => array:2 [
              "nombre" => "Emma"
              "apellidos" => "Carbonell"
            ]
            4 => array:2 [
              "nombre" => "Nuria"
              "apellidos" => "Rabella"
            ]
            5 => array:2 [
              "nombre" => "Margarita"
              "apellidos" => "del Cuerpo"
            ]
            6 => array:2 [
              "nombre" => "Elisenda"
              "apellidos" => "Moliner"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23000228?idApp=UINPBA00004N"
    "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X23000228/v1_202405030559/en/main.assets"
  ]
  "en" => array:20 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>"
    "titulo" => "Low rate of vaccination and risk of incident hepatitis A among HIV-infected men who have sex with men in Seville&#44; Southern Spain"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "251"
        "paginaFinal" => "256"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Marta Fernandez-Fuertes, Juan Macias, Ana&#239;s Corma-Gomez, Adolfo Salazar-Gonzalez, Alejandro Gonzalez-Serna, Pilar Rincon, Maria J&#46; Arriaza-Estevez, Ana Fuentes-Lopez, Luis M&#46; Real, Juan A&#46; Pineda"
        "autores" => array:10 [
          0 => array:3 [
            "nombre" => "Marta"
            "apellidos" => "Fernandez-Fuertes"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          1 => array:4 [
            "nombre" => "Juan"
            "apellidos" => "Macias"
            "email" => array:1 [
              0 => "jmacias7@us.es"
            ]
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Ana&#239;s"
            "apellidos" => "Corma-Gomez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "Adolfo"
            "apellidos" => "Salazar-Gonzalez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          4 => array:3 [
            "nombre" => "Alejandro"
            "apellidos" => "Gonzalez-Serna"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          5 => array:3 [
            "nombre" => "Pilar"
            "apellidos" => "Rincon"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          6 => array:3 [
            "nombre" => "Maria J&#46;"
            "apellidos" => "Arriaza-Estevez"
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
            ]
          ]
          7 => array:3 [
            "nombre" => "Ana"
            "apellidos" => "Fuentes-Lopez"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          8 => array:3 [
            "nombre" => "Luis M&#46;"
            "apellidos" => "Real"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn1"
              ]
            ]
          ]
          9 => array:3 [
            "nombre" => "Juan A&#46;"
            "apellidos" => "Pineda"
            "referencia" => array:4 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">e</span>"
                "identificador" => "aff0025"
              ]
              3 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">1</span>"
                "identificador" => "fn1"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:5 [
          0 => array:3 [
            "entidad" => "Institute of Biomedicine of Seville &#40;IBiS&#41;&#44; Hospital Universitario Virgen de Valme&#44; Sevilla&#44; Spain"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Department of Medicine&#44; University of Sevilla&#44; Sevilla&#44; Spain"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Microbiology Service&#44; Hospital Universitario San Cecilio&#44; Granada&#44; Spain"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Department of Surgery&#44; Biochemistry and Immunology&#44; School of Medicine&#44; University of Malaga&#44; Malaga&#44; Spain"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
          4 => array:3 [
            "entidad" => "CIBERINFEC&#44; Instituto de Salud Carlos III&#44; Madrid&#44; Spain"
            "etiqueta" => "e"
            "identificador" => "aff0025"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Baja tasa de vacunaci&#243;n y riesgo de incidencia de hepatitis A entre hombres que tienen sexo con hombres infectados por VIH en Sevilla&#44; sur de Espa&#241;a"
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1478
            "Ancho" => 2508
            "Tamanyo" => 197580
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Biannual HAV incidence in susceptible patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>272&#41;&#42;&#46; &#42;Patients vaccinated against HAV during the follow-up were censored at the date of vaccination&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">WHO estimates that approximately 1&#46;5 million people become infected by hepatitis A virus &#40;HAV&#41; every year&#46;<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> HAV is primarily spread by the fecal-oral route through person-to-person contact or by contaminated food or water&#46; Due to an improvement of health conditions and also because of the socioeconomic development&#44; the incidence of HAV infection is low in European countries&#46;<a class="elsevierStyleCrossRefs" href="#bib0160"><span class="elsevierStyleSup">2&#44;3</span></a> However&#44; spikes in the incidence rate of HAV infection have been detected in the adult population&#46; Epidemic outbreaks of the disease have occurred in Europe<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;6</span></a> and USA<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8</span></a> mainly among men who have sex with men &#40;MSM&#41; infected or not with HIV&#46;<a class="elsevierStyleCrossRefs" href="#bib0180"><span class="elsevierStyleSup">6&#44;9</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Although vaccination against HAV is an effective way to prevent individual infections and to reduce the impact of outbreaks&#44; its recommendation for adults is not included in most of the vaccination policies in European countries and USA&#46;<a class="elsevierStyleCrossRefs" href="#bib0200"><span class="elsevierStyleSup">10&#44;11</span></a> Even so&#44; when HAV vaccination is recommended in vaccination programs&#44; it is mostly approved for high-risk groups of people&#44; where HIV-infected patients are not included as one of them until recently only in some countries&#44; in 2018 in the case of Spain&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a> For that reason&#44; low rates of vaccination against HAV have been reported among risk groups as HIV-infected patients&#44; MSM or injecting drugs users &#40;IDUs&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;13</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Incidence studies based on serology and conducted in large prospective HIV-infected cohorts are needed in order to a better estimate of the real incidence of and risk factors for HAV infection among HIV-infected patients&#46; Most importantly&#44; these studies could identify people vaccinated that do not develop immunological response against the virus&#44; leaving this group of people at risk of infection&#46; To the best of our knowledge&#44; the information about factors associated with HAV infection come from case reports and cross-sectional studies<a class="elsevierStyleCrossRefs" href="#bib0185"><span class="elsevierStyleSup">7&#44;8&#44;13</span></a> with the subsequent underestimation of the real incidence of the infection&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Because of this&#44; we aimed at evaluating the incidence of and risk factors for HAV infection in HIV-infected patients in our area in recent years&#46; We also assessed the rates of HAV vaccination in this population&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Study design and patients</span><p id="par0025" class="elsevierStylePara elsevierViewall">This was a prospective cohort study&#46; The cohort includes all HIV-infected patients attending the Unit of Infectious Diseases in the Hospital Universitario Virgen de Valme from January 2008 to August 2019&#46; Patients were seen in scheduled clinical visits at least every 6 months&#46; At each visit&#44; epidemiological&#44; clinical and laboratory data were recorded&#46; A serum sample was collected and stored in each programmed visit&#46; All included patients had two or more frozen serum samples available collected at least 12 months apart&#46; Individuals with only one serum sample were excluded from the study&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Definitions and procedures</span><p id="par0030" class="elsevierStylePara elsevierViewall">Patients were classified as incident HAV infection cases if they had a baseline negative serum HAV antibody test and detectable serum HAV antibodies at the end of follow-up with an antibody cut-off &#62;20<span class="elsevierStyleHsp" style=""></span>UI&#47;mL to be considered positive titer&#46; For incident HAV cases&#44; the year of infection was determined by testing sera stored every year since baseline&#44; in order to detect the year of seroconversion&#46; Patients vaccinated against HAV during the follow-up were censored at the date of seroconversion post-vaccination&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Sera remained frozen at &#8722;80<span class="elsevierStyleHsp" style=""></span>&#176;C until thawing for the determination of HAV antibodies&#46; HAV antibodies were measured using a commercial bioluminescence immunoassay &#40;LIAISON Anti-HAV &#40;310170&#41;&#44; DiaSorin S&#46;p&#46;A&#46;&#44; Saluggia&#44; Vercelli&#44; Italy&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Vaccination took place at the Unit of Preventive Medicine in our Hospital&#46; Following the national recommendations&#44; patients received 2 doses of the vaccine 6 months apart&#46; Patients with only one dose were considered incomplete vaccinations&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Statistical analysis</span><p id="par0045" class="elsevierStylePara elsevierViewall">For descriptive analysis&#44; continuous variables were expressed as median &#40;Q1&#8211;Q3&#41; and categorical variables as frequencies &#40;percentage&#41;&#46; The &#967;<span class="elsevierStyleSup">2</span> test or Fisher&#39;s exact test were used to compare the distribution of categorical variables&#46; The Student&#39;s <span class="elsevierStyleItalic">t</span>-test or the Mann&#8211;Whitney U test were applied to compare continuous variables&#46; Global incidence and biannual incidence were calculated along with 95&#37; confidence interval &#40;95&#37; CI&#41;&#46; Binary logistic regression models were elaborated to assess the factors independently associated with HAV seroconversion among susceptible patients who had not been vaccinated&#46; In those analyses&#44; variables related to this condition with a univariate <span class="elsevierStyleItalic">p</span> value &#60;0&#46;2&#44; as well as age and sex&#44; were included&#46; Differences were considered significant for <span class="elsevierStyleItalic">p</span> values &#8804;0&#46;05&#46; The incidence of infection during outbreak periods &#40;2009&#8211;2010 and 2017&#8211;2018&#41; were compared with that observed in the period of lower incidence of infection detected &#40;2013&#8211;2014&#41; in order to find out possible different features between periods&#46; All analyses were carried out using the SPSS software 25&#46;0 &#40;IBM Corporation&#44; Somers&#44; New York City&#44; New York&#44; USA&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Ethical issues</span><p id="par0050" class="elsevierStylePara elsevierViewall">This study was designed and performed according to the Helsinki declaration and was approved by the ethics committee of the Hospital Universitario Virgen de Valme &#40;Seville&#44; Spain&#41;&#46; Informed consent was obtained from all individuals&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results</span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Characteristics of the population</span><p id="par0055" class="elsevierStylePara elsevierViewall">Of the 933 patients included in the cohort&#44; 915 finally met the inclusion criteria&#46; The baseline characteristics of the patients are summarized in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46; Most individuals showed a good immunological status &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#41;&#46; The median time of follow-up was 7&#46;7 &#40;3&#46;9&#8211;9&#46;6&#41; years&#46; There were 147 &#40;16&#46;1&#37;&#41; patients lost to follow-up and 73 &#40;8&#37;&#41; individuals died during the study&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Incidence of and risk factors for HAV infection and vaccination</span><p id="par0060" class="elsevierStylePara elsevierViewall">At baseline&#44; 272 &#40;30&#37;&#41; subjects had a negative HAV serology and 26 &#40;9&#46;5&#37;&#41; of them became infected with HAV during the study period&#46; Of those&#44; 18 &#40;69&#46;2&#37;&#41; were asymptomatic and 8 &#40;30&#46;8&#37;&#41; developed symptoms&#46; Only one &#40;12&#46;5&#37;&#41; of the symptomatic patients developed a severe acute hepatitis and needed admission&#46; All susceptible patients had a serum sample yearly until the date of seroconversion associated with infection or vaccination&#46; The median time of follow-up among susceptible individuals was 6&#46;2 &#40;3&#46;0&#8211;9&#46;6&#41; years&#46; Among patients with HAV incident infection&#44; 15 &#40;58&#37;&#41; were MSM and 11 &#40;42&#37;&#41; non-MSM individuals &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;267&#41;&#46; Biannual incident cases among all susceptible individuals are summarized in <a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#46; Annual incidence was 1&#46;54 &#40;95&#37; CI&#44; 1&#46;05&#8211;2&#46;26&#41; per 100 persons-year&#46; Biannual incidence is shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Incident cases peaked in 2009&#8211;2010 and 2017&#8211;2018 &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; MSM was de risk group more represented in the outbreaks compared with the valley period of 2013&#8211;2014 &#91;&#40;2009&#8211;2010&#58; 3 &#40;6&#46;8&#37;&#41; vs&#46; 2013&#8211;2014&#58; 1 &#40;1&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;102&#41; &#40;2017&#8211;2018&#58; 7 &#40;8&#46;0&#37;&#41; vs&#46; 2013&#8211;2014&#58; 1 &#40;1&#46;3&#37;&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;045&#41;&#93;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">The factors associated with incident infection among unvaccinated patients are shown in <a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#46; After multivariate analysis&#44; adjusted by age&#44; sex and CDC stage&#44; MSM group and age were independently associated with incident HAV infection &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">Among 272 patients with negative baseline HAV serology&#44; 105 &#40;39&#37;&#41; were vaccinated against HAV along the study period&#46; Out of those&#44; 65 &#40;61&#46;9&#37;&#41; were MSM&#46; Vaccinated patients received the first dose of vaccine a median &#40;Q1&#8211;Q3&#41; of 19 &#40;7&#8211;75&#41; months after the baseline date&#46; Seventy-six &#40;72&#46;4&#37;&#41; individuals completed the vaccination schedule with 2 doses of the vaccine&#46; Sixty-six &#40;87&#37;&#41; of them showed seroconversion after HAV vaccination&#46; Most patients with adequate vaccination showed persistent serum antibodies&#44; but one &#40;1&#46;5&#37;&#41; individual showed seroreversion 4 years after successful vaccination&#46; Among 10 &#40;13&#37;&#41; non-responders to adequate vaccination&#44; there were three &#40;30&#37;&#41; patients who seroconverted five to nine years after vaccination &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41; and they were considered as infections&#46; Among 28 &#40;27&#37;&#41; patients with an incomplete HAV vaccination schedule&#44; 11 &#40;39&#37;&#41; did not show anti-HAV seroconversion after the first and only vaccine dose&#46; One &#40;9&#46;1&#37;&#41; of them showed anti-HAV serocoversion five years after vaccination with only one dose and he was also considered as an infection&#46; The overall incidence of HAV infection for vaccinated patients was 3&#46;8&#37; &#40;4 out of 105&#41; with all of them developing asymptomatic infections&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0075" class="elsevierStylePara elsevierViewall">We found that the incidence of HAV infection&#44; confirmed by serological testing&#44; among a well-controlled HIV-infected cohort remains low and steady&#44; with periodical outbreaks involving mainly MSM&#46; The fact that a significant proportion of these patients remain susceptible to HAV infection leads to these outbreaks&#46; Insufficient vaccine coverage and limited response to vaccination underlies the elevated susceptibility to HAV infection in this population&#46; In addition&#44; these results prove that patients not responding to anti-HAV vaccination continue at risk of infection&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Our outbreaks observations are consistent with previous data in different areas in Europe mainly observed in unvaccinated MSM&#44; regardless whether they were infected <a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a> or not by HIV&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;14</span></a> Most incident HAV infections in our study were detected in MSM&#44; as in previous reports&#46;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;9&#44;13&#44;15</span></a> During our period of study two outbreaks were reported in different countries in 2008&#8211;2009<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a> and in 2016&#8211;2017&#46;<a class="elsevierStyleCrossRefs" href="#bib0175"><span class="elsevierStyleSup">5&#44;7&#44;9&#44;16</span></a> Both international outbreaks overlap in time with the outbreaks observed in our study pointing out that our serological study is in line with those surveys in the rest of Europe and USA&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">In agreement with previous observations&#44; we found a significant rate of HAV vaccine failure&#46; Immunosuppression has been reported to influence HAV vaccine response in HIV infection&#46; CD4 cell counts lower than 200<span class="elsevierStyleHsp" style=""></span>cells&#47;mcL and low CD4&#47;CD8 ratio have been associated with poorer response&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;18</span></a> For HIV viremia&#44; there are contradictory results&#44; with studies showing an association of higher levels of viremia with lack of seroconversion after vaccination&#44;<a class="elsevierStyleCrossRefs" href="#bib0245"><span class="elsevierStyleSup">19&#44;20</span></a> and other studies reporting no relationship with response to vaccination&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#44;21</span></a> In any case&#44; lower protection rates following vaccination are observed in HIV infection&#44;<a class="elsevierStyleCrossRefs" href="#bib0260"><span class="elsevierStyleSup">22&#44;23</span></a> where also specific antibodies are lower among HIV positive individuals compared with the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Although it is not clear whether those individuals should undergo HAV revaccination&#44; the loss of immunity may be addressed using additional boosters&#46;<a class="elsevierStyleCrossRefs" href="#bib0275"><span class="elsevierStyleSup">25&#8211;29</span></a> Moreover&#44; high seroconversion rates in HIV-infected population with one-dose of HAV inactivated vaccine after losing anti-HAV following primary vaccination have been reported&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a> Thus&#44; follow-up monitoring of serological response after vaccination to evaluate the need of additional booster vaccination among HIV-infected population should be implemented&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">After adequate HAV vaccination&#44; the majority of patients with initial response to vaccination showed long-term persistence of antibodies&#46; Only one patient lost anti-HAV antibodies four years after vaccination&#46; This potential loss of response over time indicates that periodic reassessment HAV serology is needed for HIV-infected patients&#46; However&#44; the more frequent reason for lack of seroprotection among vaccinated patients was an incomplete schedule of vaccination&#46; Nearly one third of the individuals who started the vaccination program did not receive the second dose of vaccine&#46; Potential explanations for this failure to complete the vaccination program include the loss of adherence to the program follow-up&#46; The tertiary care centered vaccination&#44; as opposed to administration in primary care settings&#44; is another likely barrier together with the fact that HAV vaccination was not recommended until 2018 in our country for HIV positive patients&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Asymptomatic infections are the common presentation in children&#46; On the contrary&#44; approximately 30&#37; of patients older than 6 years develop symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">24</span></a> Regarding HIV-infected patients&#44; the information is scarce about the possible differences with HIV-uninfected individuals&#46; A small study suggested no differences in the frequency or severity of symptoms&#46;<a class="elsevierStyleCrossRef" href="#bib0300"><span class="elsevierStyleSup">30</span></a> In the present study&#44; we found that one third of the patients with HAV seroconversion developed symptoms&#44; in line with the clinical picture in the general population&#46; Interestingly&#44; patients with complete or incomplete vaccination who were infected by HAV did not develop symptoms&#46; This may indicate that some low level of immunity among vaccinated HIV-infected patients&#44; below the threshold of antibody titer considered to indicate seroprotection&#44; could induce a milder hepatitis A course among&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Our study presents several limitations&#46; First&#44; this was a cohort study based on the analysis of stored sera during a long period of observation&#46; Should sera had been inconsistently gathered&#44; the estimations of incidence would have been inaccurate&#46; However&#44; we could evaluate yearly serum samples of 94&#37; patients in the cohort&#46; This is a strength of the study&#46; Second&#44; detailed sexual habits were not assessed&#44; which precludes an evaluation of sexual risk factors associated with HAV infection&#46; Third&#44; 6&#46;7&#37; vaccinated individuals lacked serological follow-up&#46; The prolonged period of follow up and the annual serology performed within a cohort of HIV-infected patients are strengths of this study&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">In conclusion&#44; insufficient immunization against HAV in HIV-infected people leads to periodic hepatitis A outbreaks&#46; Importantly&#44; patients without response to HAV vaccination are at risk of incident infection&#46; Strategies to implement widespread HAV vaccination are needed for HIV-infected people and particularly MSM HIV-infected patients&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Data availability</span><p id="par0110" class="elsevierStylePara elsevierViewall">The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request&#46;</p></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0125">Author contributions</span><p id="par0115" class="elsevierStylePara elsevierViewall">Juan Macias &#40;J&#46;M&#46;&#41; and Marta Fernandez-Fuertes &#40;M&#46;F&#46;F&#46;&#41; had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Study concept and design&#58; Juan A Pineda &#40;J&#46;A&#46;P&#46;&#41; and Luis M&#46; Real &#40;L&#46;M&#46;R&#46;&#41;&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Acquisition&#44; analysis&#44; or interpretation of data&#58; J&#46;M&#46;&#44; M&#46;F&#46;F&#46;&#44; Ana&#239;s Corma-Gomez &#40;A&#46;C&#46;G&#46;&#41;&#44; Adolfo de Salazar &#40;A&#46;S&#46;&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Statistical analysis&#58; J&#46;A&#46;P&#46; and L&#46;M&#46;R&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">Drafting of the manuscript&#58; J&#46;M&#46; and M&#46;F&#46;F&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Critical revision of the manuscript for important intellectual content&#58; J&#46;M&#46;&#44; M&#46;F&#46;F&#46;&#44; A&#46;C&#46;G&#46;&#44; A&#46;S&#46;&#44; Alejandro Gonz&#225;lez-Serna &#40;A&#46;G&#46;S&#46;&#41;&#44; Pilar RINCON &#40;P&#46;R&#46;&#41;&#44; Maria J&#46; Arriaza-Estevez &#40;M&#46;J&#46;A&#46;E&#46;&#41;&#44; Ana Fuentes-Lopez &#40;A&#46;F&#46;L&#46;&#41;&#44; L&#46;M&#46;R&#46;&#44; and J&#46;A&#46;P&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Obtained funding&#58; J&#46;M&#46;&#44; A&#46;C&#46;G&#44; A&#46;G&#46;S&#46; and J&#46;A&#46;P&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Study supervision&#58; J&#46;A&#46;P&#46; and L&#46;M&#46;R&#46;</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0130">Funding</span><p id="par0160" class="elsevierStylePara elsevierViewall">This work was supported in part by the Instituto de Salud Carlos III &#40;Project&#8217;PI16&#47;01443&#8217;&#41;&#44; integrated in the national I&#43;D&#43;i 2013-2016 and co-funded by the European Union &#40;ERDF&#47;ESF&#44;&#8220;Investing in your future&#8221;&#41;&#44; by the Spanish Network for AIDS investigation &#40;RIS&#41;&#40;<a href="http://www.red.es/redes/inicio">http&#58;&#47;&#47;www&#46;red&#46;es&#47;redes&#47;inicio</a>&#41; &#40;RD16&#47;0025&#47;0010&#41;&#44; as a part of the Nacional I&#43;D&#43;I&#44; ISCIII Subdirecci&#243;n General de Evaluaci&#243;n and the European Fund for Development of Regions &#40;FEDER&#41;&#46; This research was also supported by CIBER -Consorcio Centro de Investigaci&#243;n Biom&#233;dica en Red-&#40;CB 2021&#41;&#44; Instituto de Salud Carlos III&#44; Ministerio de Ciencia e Innovaci&#243;n and Uni&#243;n Europea-NextGenerationEU&#46; JAP has received a research extension grant from the Programa de Intensificaci&#243;n de la Actividad de Investigaci&#243;n del Servicio Nacional de Salud Carlos III &#40;I3SNS&#41;&#46; JM has received a research extension grant from Consejer&#237;a de Salud&#44; Junta de Andaluc&#237;a &#40;A1-0060-2021&#41;&#46; A&#46;C-G has received a research extension grant Acci&#243;n B&#44; Acci&#243;n para el Refuerzo de la Actividad Investigadora en las Unidades Cl&#237;nicas del Servicio Andaluz de Salud 2021&#44; Cl&#237;nicos Investigadores &#40;grant number B-0061-2021&#41;&#46; This work was supported by the Ministry of Science&#44; Innovation and Universities of Spain for A&#46;G&#46;-S who is recipient of a Miguel Servet Research Contract &#40;CP18&#47;00146&#41;&#44; co-financed by the FSE&#8217;El Fondo Social Europeo invierte en tu futuro&#8217;&#46;</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0135">Conflict of interests</span><p id="par0155" class="elsevierStylePara elsevierViewall">JM has been an investigator in clinical trials supported by Bristol-Myers Squibb&#44; Gilead and Merck Sharp &#38; Dome&#46; He has received lectures fees from Gilead&#44; Bristol-Myers Squibb&#44; and Merck Sharp &#38; Dome&#44; and consulting fees from Bristol Myers-Squibb&#44; Gilead&#44; and Merck Sharp &#38; Dome&#46; JAP reports having received consulting fees from Bristol-Myers Squibb&#44; Abbvie&#44; ViiV Healthcare&#44; Gilead&#44; Merck Sharp &#38; Dome&#44; and Janssen Cilag&#46; He has received research support from Bristol-Myers Squibb&#44; ViiV Healthcare&#44; Abbvie&#44; Merck Sharp &#38; Dome&#44; Janssen Cilag and Gilead and has received lecture fees from Abbvie&#44; Bristol-Myers Squibb&#44; ViiV Healthcare&#44; Merck Sharp &#38; Dome&#44; Abbvie&#44; Janssen Cilag&#44; and Gilead&#46; ACG has received lecture fees from Gilead&#44; Merck Sharp &#38; Dome and Abbvie&#46; The remaining authors report no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:13 [
        0 => array:3 [
          "identificador" => "xres2138628"
          "titulo" => "Abstract"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Methods"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Results"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1815772"
          "titulo" => "Keywords"
        ]
        2 => array:3 [
          "identificador" => "xres2138629"
          "titulo" => "Resumen"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Introducci&#243;n"
            ]
            1 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Objetivo"
            ]
            2 => array:2 [
              "identificador" => "abst0035"
              "titulo" => "M&#233;todos"
            ]
            3 => array:2 [
              "identificador" => "abst0040"
              "titulo" => "Resultados"
            ]
            4 => array:2 [
              "identificador" => "abst0045"
              "titulo" => "Conclusiones"
            ]
          ]
        ]
        3 => array:2 [
          "identificador" => "xpalclavsec1815773"
          "titulo" => "Palabras clave"
        ]
        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
          "secciones" => array:4 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Study design and patients"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Definitions and procedures"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Statistical analysis"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Ethical issues"
            ]
          ]
        ]
        6 => array:3 [
          "identificador" => "sec0035"
          "titulo" => "Results"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0040"
              "titulo" => "Characteristics of the population"
            ]
            1 => array:2 [
              "identificador" => "sec0045"
              "titulo" => "Incidence of and risk factors for HAV infection and vaccination"
            ]
          ]
        ]
        7 => array:2 [
          "identificador" => "sec0050"
          "titulo" => "Discussion"
        ]
        8 => array:2 [
          "identificador" => "sec0055"
          "titulo" => "Data availability"
        ]
        9 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Author contributions"
        ]
        10 => array:2 [
          "identificador" => "sec0070"
          "titulo" => "Funding"
        ]
        11 => array:2 [
          "identificador" => "sec0065"
          "titulo" => "Conflict of interests"
        ]
        12 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2023-02-09"
    "fechaAceptado" => "2023-03-08"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1815772"
          "palabras" => array:4 [
            0 => "HIV"
            1 => "Hepatitis A"
            2 => "Vaccination"
            3 => "Incidence"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1815773"
          "palabras" => array:4 [
            0 => "VIH"
            1 => "Hepatitis A"
            2 => "Vacunaci&#243;n"
            3 => "Incidencia"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Periodic outbreaks of hepatitis A &#40;HAV&#41; infection in men who have sex with men &#40;MSM&#41; have been reported&#46; Low vaccination uptake in HIV-infected individuals could drive new outbreaks&#46; We aimed at evaluating the incidence of and risk factors for HAV infection in people living with HIV &#40;PLWH&#41; in our area&#46; We also assessed the rates of HAV vaccination&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Methods</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">This was a prospective cohort study&#46; 915 patients were included&#44; 272 &#40;30&#37;&#41; of them were anti-HAV seronegative at baseline&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Twenty-six &#40;9&#46;6&#37;&#41; susceptible individuals became infected&#46; Incident cases peaked in 2009&#8211;2010 and 2017&#8211;2018&#46; Incident HAV infection was independently associated with MSM &#91;adjusted odds ratio &#40;95&#37; confidence ratio&#41;&#58; 4&#46;39 &#40;1&#46;35&#8211;14&#46;27&#41;&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;014&#93;&#46; One hundred and five &#40;38&#46;6&#37;&#41; HAV seronegative patients were vaccinated&#44; 21 &#40;20&#37;&#41; of them did not respond&#44; and one &#40;1&#37;&#41; patient lost immunity against HAV&#46; Four &#40;29&#37;&#41; non-responders to vaccination showed incident HAV 5&#8211;9 years afterwards&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">The incidence of HAV infection in a cohort of well-controlled PLWH remains low and stable&#44; with intermittent outbreaks involving mainly non-immunized MSM&#46; A significant proportion of PLWH remain susceptible to HAV infection due to insufficient vaccine uptake and limited response to vaccination&#46; Importantly&#44; patients not responding to HAV vaccination continue at risk of infection&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Conclusions"
          ]
        ]
      ]
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducci&#243;n</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Se han notificado brotes peri&#243;dicos de infecci&#243;n por hepatitis<span class="elsevierStyleHsp" style=""></span>A &#40;VHA&#41; en hombres que practican sexo con hombres &#40;HSH&#41;&#46; La baja tasa de vacunaci&#243;n en personas infectadas por el VIH podr&#237;a dar lugar a nuevos brotes&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Objetivo</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Evaluar la incidencia y los factores de riesgo de la infecci&#243;n por VHA en personas que viven con el VIH &#40;PVVS&#41; en nuestra &#225;rea&#46; Se evaluaron tambi&#233;n las tasas de vacunaci&#243;n frente al VHA&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">M&#233;todos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio de cohortes prospectivo en el que se incluyeron 915 pacientes&#44; 272 &#40;30&#37;&#41; de los cuales eran seronegativos frente al VHA al inicio del estudio&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Veintis&#233;is &#40;9&#44;6&#37;&#41; individuos susceptibles se infectaron&#46; Los casos incidentes alcanzaron su punto m&#225;ximo en 2009-2010 y en 2017-2018&#46; La infecci&#243;n incidente por VHA se asoci&#243; de forma independiente con HSH &#40;odds ratio ajustada &#91;&#237;ndice de confianza del 95&#37;&#93;&#58; 4&#44;39 &#91;1&#44;35-14&#44;27&#93;&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;014&#41;&#46; Ciento cinco &#40;38&#44;6&#37;&#41; pacientes seronegativos frente al VHA fueron vacunados&#44; 21 &#40;20&#37;&#41; de ellos no respondieron y un paciente &#40;1&#37;&#41; perdi&#243; la inmunidad frente al VHA&#46; Cuatro &#40;29&#37;&#41; pacientes que no respondieron a la vacunaci&#243;n presentaron infecci&#243;n por el VHA entre 5 y 9<span class="elsevierStyleHsp" style=""></span>a&#241;os despu&#233;s&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">La incidencia de la infecci&#243;n por VHA en una cohorte de PVVS bien controlada sigue siendo baja y estable&#44; con brotes intermitentes que afectan principalmente a HSH no inmunizados&#46; Una proporci&#243;n significativa de PVVS sigue siendo susceptible a la infecci&#243;n por VHA debido a la insuficiente vacunaci&#243;n y a la respuesta limitada a la misma&#46; Es importante destacar que los pacientes que no responden a la vacunaci&#243;n frente al VHA siguen estando en riesgo de infecci&#243;n&#46;</p></span>"
        "secciones" => array:5 [
          0 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Objetivo"
          ]
          2 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "M&#233;todos"
          ]
          3 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Resultados"
          ]
          4 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusiones"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:3 [
        "etiqueta" => "1"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0030">Equal contribution&#46;</p>"
        "identificador" => "fn1"
      ]
    ]
    "multimedia" => array:5 [
      0 => array:7 [
        "identificador" => "fig0005"
        "etiqueta" => "Fig&#46; 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 1478
            "Ancho" => 2508
            "Tamanyo" => 197580
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Biannual HAV incidence in susceptible patients &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>272&#41;&#42;&#46; &#42;Patients vaccinated against HAV during the follow-up were censored at the date of vaccination&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; PWID&#58; people who inject drugs&#59; MSM&#58; men who have sex with men&#59; AIDS&#58; acquired immunodeficiency syndrome&#59; HCV&#58; hepatitis C virus&#59; Ab&#58; antibody&#59; HBsAg&#58; surface antigen of the hepatitis B virus&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Characteristic&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Male sex&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">743 &#40;81&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age&#44;</span><span class="elsevierStyleItalic">years</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53 &#40;47&#8211;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="2" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HIV transmission&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PWID&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">470 &#40;51&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">230 &#40;25&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heterosexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">179 &#40;19&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34 &#40;3&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">AIDS&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">256 &#40;28&#46;0&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Undetectable plasma HIV</span><span class="elsevierStyleItalic">RNA</span><a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">b</span></a><span class="elsevierStyleItalic">&#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">582 &#40;63&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">CD4</span><span class="elsevierStyleSup"><span class="elsevierStyleItalic">&#43;</span></span><span class="elsevierStyleItalic">cell count&#47;&#956;l</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">495 &#40;304&#8211;687&#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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Positive anti-HCV Ab&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">523 &#40;57&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">HBsAg&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">31 &#40;3&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Detectable plasma HCV RNA&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">368 &#40;40&#46;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="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Positive anti-HAV&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">637 &#40;69&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3525387.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Median &#40;Q1&#8211;Q3&#41;&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Less than 20<span class="elsevierStyleHsp" style=""></span>copies&#47;&#956;l&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Baseline characteristics of the study population &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>915&#41;&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at2"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; CI&#58; confidence interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Number of cases&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Incidence&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CI 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2009&#8211;2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;40&#8211;1&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&#8211;2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;45&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;17&#8211;1&#46;20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2013&#8211;2014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;02&#8211;0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2015&#8211;2016&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;22&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;06&#8211;0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2017&#8211;2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;80&#8211;2&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2019&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3525389.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">Biannual HAV incidence &#40;100 persons-year&#41;&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Abbreviations</span>&#58; MSM&#58; men who have sex with men&#59; CDC stage&#58; centers of disease control and prevention stage&#59; AOR&#58; adjusted odd ratio&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Parameter&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Frequency of HAV infection<span class="elsevierStyleItalic">N</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> univariate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">AOR &#40;95&#37; CI&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">p</span> multivariate&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sex</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;4&#46;7&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;99 &#40;0&#46;61&#8211;14&#46;73&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;178&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">124&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">24 &#40;19&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Age</span><a class="elsevierStyleCrossRef" href="#tblfn0015"><span class="elsevierStyleSup">a</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">14 &#40;17&#46;5&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;509&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&#46;08 &#40;1&#46;02&#8211;1&#46;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805;46&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12 &#40;13&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Risk group</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>MSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">63&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15 &#40;23&#46;8&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;022&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#46;39 &#40;1&#46;35&#8211;14&#46;27&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;014&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>No MSM&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11 &#40;10&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Plasma HIV</span><span class="elsevierStyleItalic">RNA</span><a class="elsevierStyleCrossRef" href="#tblfn0020"><span class="elsevierStyleSup">b</span></a></td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Detectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">114&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;14&#46;9&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;731&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Undetectable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">53&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;17&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CDC stage</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>C&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3 &#40;8&#46;3&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;170&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;29 &#40;0&#46;07&#8211;1&#46;28&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;109&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A or B&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">131&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23 &#40;17&#46;6&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="6" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">CD4 cell count&#47;ml</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#60;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">49&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;18&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;603&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#62;350&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">118&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17 &#40;14&#46;4&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3525388.png"
              ]
            ]
          ]
          "notaPie" => array:2 [
            0 => array:3 [
              "identificador" => "tblfn0015"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Entered as a continuous variable in the multivariate analysis&#46;</p>"
            ]
            1 => array:3 [
              "identificador" => "tblfn0020"
              "etiqueta" => "b"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0020">Less than 20<span class="elsevierStyleHsp" style=""></span>copies&#47;&#956;l&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">Univariate and multivariate analysis of risk factors associated with incident HAV infection among unvaccinated individuals &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>167&#41;&#46;</p>"
        ]
      ]
      4 => array:8 [
        "identificador" => "tbl0020"
        "etiqueta" => "Table 4"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at4"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Patient 4 was incompletely vaccinated&#44; received only the first dose&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                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="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">First dose date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Second dose date&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Time between the last dose and the date of seroconversion<a class="elsevierStyleCrossRef" href="#tblfn0025"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Seroconversion year&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">June 22nd&#44; 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">December 21st&#44; 2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">April&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">May 27th&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">October 21st&#44; 2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">September&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">January 20th&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">November 22nd&#44; 2010&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">June&#44; 2018&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Patient 4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March 22nd&#44; 2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#8211;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5 years&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">March&#44; 2017&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab3525390.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0025"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0025">All patients showed negative anti-HAV serology score yearly since the last dose of HAV vaccine until the date of seroconversion&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Characteristics of vaccinated individuals who became infected with HAV &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#41;&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:30 [
            0 => array:3 [
              "identificador" => "bib0155"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "World Health Organization&#46; Global hepatitis report&#44; 2017&#46; Global Hepatitis Programme&#46; WHO&#59; 2017 &#91;accesed Dec 5 2022&#93;&#46; <a target="_blank" href="http://who.int/publications/i/item/global-hepatitis-report-2017">http&#58;&#47;&#47;who&#46;int&#47;publications&#47;i&#47;item&#47;global-hepatitis-report-2017</a>&#46;"
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0160"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Seroprevalence and susceptibility to hepatitis A in the European Union and European Economic area&#58; a systematic review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Carrillo-Santisteve"
                            1 => "L&#46; Tavoschi"
                            2 => "E&#46; Severi"
                            3 => "S&#46; Bonfigli"
                            4 => "M&#46; Edelstein"
                            5 => "E&#46; Bystr&#246;m"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Lancet Infect Dis"
                        "fecha" => "2017"
                        "volumen" => "17"
                        "paginaInicial" => "306"
                        "paginaFinal" => "319"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0165"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Globalization and the changing epidemiology of hepatitis A virus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "K&#46;H&#46; Jacobsen"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:3 [
                        "tituloSerie" => "Cold Spring Harb Perspect Med"
                        "fecha" => "2018"
                        "volumen" => "8"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0170"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Monophyletic outbreak of hepatitis A involving HIV-infected men who have sex with men&#44; Rome&#44; Italy 2008&#8211;2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Bordi"
                            1 => "G&#46; Rozera"
                            2 => "P&#46; Scognamiglio"
                            3 => "C&#46; Minosse"
                            4 => "M&#46; Loffredo"
                            5 => "A&#46; Antinori"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Clin Virol"
                        "fecha" => "2012"
                        "volumen" => "54"
                        "paginaInicial" => "26"
                        "paginaFinal" => "29"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0175"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis A outbreak among men who have sex with men &#40;MSM&#41; predominantly linked with the EuroPride&#44; the Netherlands&#44; July 2016 to February 2017"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;S&#46; Freidl"
                            1 => "G&#46;J&#46; Sonder"
                            2 => "L&#46;P&#46; Bov&#233;e"
                            3 => "I&#46;H&#46; Friesema"
                            4 => "G&#46;G&#46; van RIjckevorsel"
                            5 => "W&#46;L&#46; Ruijs"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eurosurveillance"
                        "fecha" => "2017"
                        "volumen" => "22"
                        "paginaInicial" => "1"
                        "paginaFinal" => "5"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0180"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outbreak of hepatitis A associated with men who have sex with men &#40;MSM&#41;&#44; England&#44; July 2016 to January 2017"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Beebeejaun"
                            1 => "S&#46; Degala"
                            2 => "K&#46; Balogun"
                            3 => "I&#46; Simms"
                            4 => "S&#46;C&#46; Woodhall"
                            5 => "E&#46; Heinsbroek"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eurosurveillance"
                        "fecha" => "2017"
                        "volumen" => "22"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0185"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis A virus immunity and vaccination among at-risk persons receiving HIV medical care"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46;P&#46; DeGroote"
                            1 => "C&#46;L&#46; Mattson"
                            2 => "Y&#46; Tie"
                            3 => "J&#46;T&#46; Brooks"
                            4 => "S&#46; Garg"
                            5 => "J&#46; Weiser"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.pmedr.2018.06.006"
                      "Revista" => array:6 [
                        "tituloSerie" => "Prev Med Rep"
                        "fecha" => "2018"
                        "volumen" => "11"
                        "paginaInicial" => "139"
                        "paginaFinal" => "144"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30003012"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0190"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Susceptibility to hepatitis A virus infection in the United States&#44; 2007&#8211;2016"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Yin"
                            1 => "L&#46; Barker"
                            2 => "K&#46;N&#46; Ly"
                            3 => "G&#46; Kilmer"
                            4 => "M&#46;A&#46; Foster"
                            5 => "J&#46; Drobeniuc"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2020"
                        "volumen" => "71"
                        "paginaInicial" => "571"
                        "paginaFinal" => "579"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0195"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis a outbreak disproportionately affecting men who have sex with men &#40;MSM&#41; in the European union and European economic area&#44; June 2016 to May 2017"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46; Ndumbi"
                            1 => "G&#46;S&#46; Freidl"
                            2 => "C&#46;J&#46; Williams"
                            3 => "O&#46; Mardh"
                            4 => "C&#46; Varela"
                            5 => "A&#46; Avellon"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Eurosurveillance"
                        "fecha" => "2018"
                        "volumen" => "23"
                        "paginaInicial" => "1"
                        "paginaFinal" => "12"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0200"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Vaccination programs for adults in Europe&#44; 2019"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "D&#46;C&#46; Cassimos"
                            1 => "E&#46; Effraimidou"
                            2 => "S&#46; Medic"
                            3 => "T&#46; Konstantinidis"
                            4 => "M&#46; Theodoridou"
                            5 => "H&#46;C&#46; Maltezou"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1038/s41541-022-00593-8"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccines"
                        "fecha" => "2020"
                        "volumen" => "8"
                        "paginaInicial" => "1"
                        "paginaFinal" => "15"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/36650164"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0205"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Center of Disease Control and Prevention&#46; Recommended adult immunization schedule CDC 2019 guidelines&#59; 2020 &#91;accesed Jan 8 2023&#93;&#46; <a target="_blank" href="http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5753a6.htm">http&#58;&#47;&#47;www&#46;cdc&#46;gov&#47;mmwr&#47;preview&#47;mmwrhtml&#47;mm5753a6&#46;htm</a>&#46;"
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0210"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Comisi&#243;n de Salud P&#250;blica del Consejo Interterritorial del Sistema Nacional de Salud&#46; Ministerio de Sanidad&#44; Consumo y Bienestar Social&#46; Ponencia de Programa y Registro de Vacunaciones&#46; Vacunaci&#243;n en grupos de riesgo de todas las edades y en determinadas situaciones&#59; 2018&#44; pp&#46; 1&#8211;165&#46;"
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0215"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of hepatitis A in Greece in the last decade&#46; Management of reported cases and outbreaks and lessons learned"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46; Mellou"
                            1 => "A&#46; Chrysostomou"
                            2 => "T&#46; Sideroglou"
                            3 => "M&#46; Kyritsi"
                            4 => "T&#46; Georgakopoulou"
                            5 => "S&#46; Tsiodras"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1017/S0950268820002721"
                      "Revista" => array:6 [
                        "tituloSerie" => "Epidemiol Infect"
                        "fecha" => "2020"
                        "volumen" => "148"
                        "paginaInicial" => "1"
                        "paginaFinal" => "6"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/33153501"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0220"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A new pattern in hepatitis A virus infection in an urban population"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "H&#46; Mart&#237;nez Lozano"
                            1 => "A&#46; Conthe Alonso"
                            2 => "R&#46; Ba&#241;ares"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.17235/reed.2020.6526/2019"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rev Esp Enferm Dig"
                        "fecha" => "2020"
                        "volumen" => "112"
                        "paginaInicial" => "178"
                        "paginaFinal" => "182"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32081016"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0225"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Trends in condom use among MSM in the United States&#58; The role of antiretroviral therapy and seroadaptive strategies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46; Paz-Bailey"
                            1 => "M&#46;C&#46; Mendoza"
                            2 => "T&#46; Finlayson"
                            3 => "C&#46; Wejnert"
                            4 => "B&#46; Le"
                            5 => "C&#46; Rose"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QAD.0000000000001139"
                      "Revista" => array:6 [
                        "tituloSerie" => "AIDS"
                        "fecha" => "2016"
                        "volumen" => "30"
                        "paginaInicial" => "1985"
                        "paginaFinal" => "1990"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27149088"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0230"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Outbreak of hepatitis A among men who have sex with men in Barcelona&#44; Spain&#44; September 2008&#8211;March 2009"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Tortajada"
                            1 => "P&#46;G&#46; de Olalla"
                            2 => "R&#46;M&#46; Pinto"
                            3 => "A&#46; Bosch"
                            4 => "J&#46; Cayl&#224;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Euro Surveill"
                        "fecha" => "2009"
                        "volumen" => "14"
                        "paginaInicial" => "20"
                        "paginaFinal" => "22"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0235"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immune response to hepatitis A vaccination in HIV-infected men in Greece"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Kourkounti"
                            1 => "N&#46; Mavrianou"
                            2 => "A&#46;V&#46; Paparizos"
                            3 => "K&#46; Kyriakis"
                            4 => "M&#46; Hatzivassiliou"
                            5 => "T&#46; Kordosis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1258/ijsa.2011.011297"
                      "Revista" => array:6 [
                        "tituloSerie" => "Int J STD AIDS"
                        "fecha" => "2012"
                        "volumen" => "23"
                        "paginaInicial" => "464"
                        "paginaFinal" => "467"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22843998"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0240"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of acute hepatitis A infection in an HIV-positive patient despite complete hepatitis A vaccination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "C&#46; Fritzsche"
                            1 => "M&#46; Loebermann"
                            2 => "E&#46;C&#46; Reisinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s15010-018-1129-1"
                      "Revista" => array:6 [
                        "tituloSerie" => "Infection"
                        "fecha" => "2018"
                        "volumen" => "46"
                        "paginaInicial" => "565"
                        "paginaFinal" => "567"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29542052"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0245"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Predictors of immunity after hepatitis a vaccination in HIV-infected persons"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "E&#46;T&#46; Overton"
                            1 => "D&#46; Nurutdinova"
                            2 => "S&#46; Sungkanuparph"
                            3 => "W&#46; Seyfried"
                            4 => "R&#46;K&#46; Groger"
                            5 => "W&#46;G&#46; Powderly"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2893.2006.00822.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Viral Hepat"
                        "fecha" => "2007"
                        "volumen" => "14"
                        "paginaInicial" => "189"
                        "paginaFinal" => "193"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17305885"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0250"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term durability of immune responses after hepatitis A vaccination among HIV-infected adults"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "N&#46;F&#46; Crum-Cianflone"
                            1 => "K&#46; Wilkins"
                            2 => "A&#46;W&#46; Lee"
                            3 => "A&#46; Grosso"
                            4 => "M&#46;L&#46; Landrum"
                            5 => "A&#46; Weintrob"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/infdis/jir180"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2011"
                        "volumen" => "203"
                        "paginaInicial" => "1815"
                        "paginaFinal" => "1823"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21606540"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0255"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immune response to hepatitis A vaccine in patients with HIV"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "C&#46; Fritzsche"
                            1 => "L&#46; Bergmann"
                            2 => "M&#46; Loebermann"
                            3 => "A&#46; Glass"
                            4 => "E&#46;C&#46; Reisinger"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.vaccine.2019.02.064"
                      "Revista" => array:6 [
                        "tituloSerie" => "Vaccine"
                        "fecha" => "2019"
                        "volumen" => "37"
                        "paginaInicial" => "2278"
                        "paginaFinal" => "2283"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30890384"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0260"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis B and A vaccination in HIV-infected adults&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Mena"
                            1 => "A&#46;L&#46; Garc&#237;a-Basteiro"
                            2 => "J&#46;M&#46; Bayas"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hum Vaccines Immunother"
                        "fecha" => "2015"
                        "volumen" => "11"
                        "paginaInicial" => "2582"
                        "paginaFinal" => "2598"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0265"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis A vaccine immunogenicity in patients using immunosuppressive drugs&#58; a systematic review and meta-analysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "H&#46;M&#46; Garcia Garrido"
                            1 => "A&#46;M&#46; Veurink"
                            2 => "M&#46; Leeflang"
                            3 => "R&#46; Spijker"
                            4 => "A&#46; Goorhuis"
                            5 => "M&#46;P&#46; Grobusch"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.tmaid.2019.101479"
                      "Revista" => array:5 [
                        "tituloSerie" => "Travel Med Infect Dis"
                        "fecha" => "2019"
                        "volumen" => "32"
                        "paginaInicial" => "101479"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31521804"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0270"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis A virus infection and hepatitis A vaccination in human immunodeficiency virus-positive patients&#58; a review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "K&#46;Y&#46; Lin"
                            1 => "G&#46;J&#46; Chen"
                            2 => "Y&#46;L&#46; Lee"
                            3 => "Y&#46;C&#46; Huang"
                            4 => "A&#46; Cheng"
                            5 => "H&#46;Y&#46; Sun"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "World J Gastroenterol"
                        "fecha" => "2017"
                        "volumen" => "23"
                        "paginaInicial" => "3589"
                        "paginaFinal" => "3606"
                        "itemHostRev" => array:3 [
                          "pii" => "S0049017220302109"
                          "estado" => "S300"
                          "issn" => "00490172"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            24 => array:3 [
              "identificador" => "bib0275"
              "etiqueta" => "25"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Long-term durability of responses to 2 or 3 doses of hepatitis a vaccination in human immunodeficiency virus-positive adults on antiretroviral therapy"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Cheng"
                            1 => "S&#46;Y&#46; Chang"
                            2 => "H&#46;Y&#46; Sun"
                            3 => "M&#46;S&#46; Tsai"
                            4 => "W&#46;C&#46; Liu"
                            5 => "Y&#46;C&#46; Su"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1093/infdis/jiw605"
                      "Revista" => array:7 [
                        "tituloSerie" => "J Infect Dis"
                        "fecha" => "2017"
                        "volumen" => "215"
                        "paginaInicial" => "606"
                        "paginaFinal" => "613"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28011921"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S2213260020300369"
                          "estado" => "S300"
                          "issn" => "22132600"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            25 => array:3 [
              "identificador" => "bib0280"
              "etiqueta" => "26"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Immunological efficacy of a three-dose schedule of hepatitis A vaccine in HIV-infected adults&#58; HEPAVAC study"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "O&#46; Launay"
                            1 => "S&#46; Grabar"
                            2 => "E&#46; Gordien"
                            3 => "C&#46; Desaint"
                            4 => "D&#46; Jegou"
                            5 => "S&#46; Abad"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1097/QAI.0b013e318183a9c0"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Acquir Immune Defic Syndr"
                        "fecha" => "2008"
                        "volumen" => "49"
                        "paginaInicial" => "272"
                        "paginaFinal" => "275"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18845961"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            26 => array:3 [
              "identificador" => "bib0285"
              "etiqueta" => "27"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Serological responses to revaccination with hepatitis A virus &#40;HAV&#41; vaccines among HIV-positive individuals whose anti-HAV antibody waned after primary vaccination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "G&#46;J&#46; Chen"
                            1 => "H&#46;Y&#46; Sun"
                            2 => "K&#46;Y&#46; Lin"
                            3 => "A&#46; Cheng"
                            4 => "Y&#46;C&#46; Huang"
                            5 => "S&#46;M&#46; Hsieh"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/liv.13665"
                      "Revista" => array:7 [
                        "tituloSerie" => "Liver Int"
                        "fecha" => "2018"
                        "volumen" => "38"
                        "paginaInicial" => "1198"
                        "paginaFinal" => "1205"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29240985"
                            "web" => "Medline"
                          ]
                        ]
                        "itemHostRev" => array:3 [
                          "pii" => "S0140673616002324"
                          "estado" => "S300"
                          "issn" => "01406736"
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            27 => array:3 [
              "identificador" => "bib0290"
              "etiqueta" => "28"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hepatitis A vaccination"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Zhang"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Hum Vaccines Immunother"
                        "fecha" => "2020"
                        "volumen" => "16"
                        "paginaInicial" => "1"
                        "paginaFinal" => "9"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            28 => array:3 [
              "identificador" => "bib0295"
              "etiqueta" => "29"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Early seroreversion after 2 doses of hepatitis A vaccination in human immunodeficiency virus &#8211; positive patients&#58; incidence and associated factors"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46;H&#46; Huang"
                            1 => "C&#46;H&#46; Huang"
                            2 => "N&#46;C&#46; Wang"
                            3 => "T&#46;C&#46; Chen"
                            4 => "Y&#46;T&#46; Lee"
                            5 => "S&#46;P&#46; Lin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1002/hep.30495"
                      "Revista" => array:6 [
                        "tituloSerie" => "Hepatology"
                        "fecha" => "2019"
                        "volumen" => "70"
                        "paginaInicial" => "465"
                        "paginaFinal" => "475"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/30614542"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            29 => array:3 [
              "identificador" => "bib0300"
              "etiqueta" => "30"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Influence of human immunodeficiency virus type 1 infection on acute hepatitis A virus infection"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "S&#46; Ida"
                            1 => "N&#46; Tachikawa"
                            2 => "A&#46; Nakajima"
                            3 => "D&#46; Manabu"
                            4 => "Y&#46; Michitami"
                            5 => "K&#46; Yoshimi"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1086/338152"
                      "Revista" => array:6 [
                        "tituloSerie" => "Clin Infect Dis"
                        "fecha" => "2002"
                        "volumen" => "34"
                        "paginaInicial" => "379"
                        "paginaFinal" => "385"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11774086"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/0213005X/0000004200000005/v1_202405030559/S0213005X23000307/v1_202405030559/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "8591"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Originales"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/0213005X/0000004200000005/v1_202405030559/S0213005X23000307/v1_202405030559/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23000307?idApp=UINPBA00004N"
]