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Original article
High prevalence and incidence of HPV-related anal cancer precursor lesions in HIV-positive women in the late HAART era
Alta prevalencia e incidencia de lesiones precursoras de cáncer anal asociada a la infección por VPH en mujeres VIH positivas en la era tardía del TAR
Carmen Hidalgo-Tenorioa,
Corresponding author
chidalgo72@gmail.com

Corresponding author.
, Samantha E. de Jesusa, Javier Esquiviasb, Juan Pasquaua
a Servicio de Enfermedades Infecciosas, Hospital Universitario Virgen de las Nieves, Granada, Spain
b Servicio de Anatomía Patológica, Hospital Universitario Virgen de las Nieves, Granada, Spain
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was introduced&#46; After ART was introduced and screening programmes for CC were established&#44; a significant reduction in its incidence occurred&#46;<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">4</span></a> The effect that ART could have on the onset of AC has been a matter of debate&#46; Studies conducted before it was administered or close to when it was introduced found an increased incidence which might have been linked to increased patient survival&#46;<a class="elsevierStyleCrossRefs" href="#bib0190"><span class="elsevierStyleSup">5&#8211;8</span></a> However&#44; more recent studies conducted in seropositive MSM have found that antiretroviral therapy could have a certain protective effect in the presence of a high-grade intraepithelial lesion or precursor lesion &#40;HSIL&#41; and AC&#46;<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#8211;11</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">For now&#44; there is no consensus or consistency among the various HIV scientific associations with respect to recommendations on screening for HSIL and AC&#8212;not only in terms of procedure and technique&#44; but also in terms of type of patient to be screened&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">12&#44;13</span></a> In Spain&#44; the 2017 GESIDA consensus document on diagnosis and treatment of sexually transmitted infections in adults&#44; children and adolescents includes performing anal cytology in HIV-positive patients with condylomas&#44; MSM and women with cervical dysplasia&#46;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">12</span></a> Cytology is the most commonly used technique to screen for HSIL and CA&#46; However&#44; the sensitivity of this tool is variable and limited&#46; This means that a non-negligible percentage of patients with these lesions are underdiagnosed&#44; as some studies have shown&#46;<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">14&#8211;16</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">With this study we sought to evaluate the prevalence and incidence of HSIL and AC in our cohort of seropositive women &#40;HIV&#43;W&#41;&#44; and to compare them with women with CC&#46; We also sought to analyse the percentage of women who acquire and clear infection with oncogenic genotypes of HPV in the anal canal and the predictive factors for the appearance of these genotypes in the anus&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Patients and methods</span><p id="par0020" class="elsevierStylePara elsevierViewall">Design&#58; a single-centre&#44; longitudinal&#44; prospective study consisting of HIV&#43;W who were consecutively enrolled&#44; after signing the informed consent form&#44; in a programme for screening&#44; diagnosis&#44; treatment and follow-up of dysplastic lesions of the anal mucosa &#40;May 2012&#8211;December 2016&#41;&#46; The patients were recruited from the infectious disease unit at a Spanish tertiary hospital&#46; The study was evaluated and approved by the independent ethics committee of the centre where the patients were recruited&#46; Inclusion criteria&#58; &#62;18 years of age&#44; HIV&#43;W&#46; Exclusion criteria&#58; men with HIV infection and a history of anal canal neoplasm&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">At the visit&#44; the patients were informed of the study conditions and objectives and provided with an informed consent form to sign&#46; Their epidemiological&#44; clinical and laboratory data were collected and processed according to the current Spanish data protection legislation &#40;Organic Law 15&#47;1999&#44; of 13 December&#44; on Personal Data Protection&#41;&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">At the baseline visit &#40;V1&#41; and subsequent visits &#40;Vx&#41;&#44; the following were collected&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">-</span><p id="par0035" class="elsevierStylePara elsevierViewall">Clinical&#47;epidemiological variables&#58; age&#44; history of perianal&#47;genital condylomas and cervical disease &#40;CIN 1&#47;2&#47;3 and CC&#41;&#44; sex and number of sexual partners in the last 12 months and throughout life&#44; anal sex&#44; use of a condom&#44; smoking&#44; alcohol use &#40;standard drink units &#91;SDUs&#93;&#41;&#44; parenteral drug addiction &#40;PDA&#41;&#44; nationality&#44; level of education&#44; months since HIV diagnosis&#44; stage of HIV according to CDC classification&#59; months in antiretroviral treatment &#40;ART&#41;&#44; virologic failure &#40;defined as viral RNA &#62;50<span class="elsevierStyleHsp" style=""></span>copies&#47;ml in at least two determinations in the past 6 months&#41; and use of concomitant treatment&#46; Other infections&#58; chronic liver disease due to hepatitis B virus &#40;HBV&#41; or hepatitis C virus &#40;HCV&#41;&#44; positive serology for syphilis and other sexually transmitted diseases&#44; and latent tuberculosis infection &#40;treated or active&#41;&#46;</p></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">-</span><p id="par0040" class="elsevierStylePara elsevierViewall">The laboratory variables included were nadir CD4 lymphocyte count&#59; CD4 count and viral load at the time of HIV diagnosis&#59; and CD4 count&#44; CD8 count and viral load at the time of enrolment in the study&#46;</p></li></ul></p><p id="par0045" class="elsevierStylePara elsevierViewall">At V1 and Vx&#44; 2 samples were taken from the mucosa of the anal canal with a pair of cotton swabs soaked in normal saline&#58; one for HPV detection and genotyping through a qualitative polymerase chain reaction &#40;PCR&#41; &#40;Linear Array HPV Genotyping Test&#41;&#44; performed with the GeneAmp PCR System 9700 thermal cycler &#40;Applied Biosystems&#44; Roche&#44; Switzerland&#41;&#44; and one for cytology&#46; Both samples were immersed in a liquid medium &#40;thin-layer liquid&#41;&#46; The thin-layer technique was used for the cytology study &#40;ThinPrep 2000 processor&#44; Hologic&#41;&#46; Both samples were sent to the pathology laboratory&#44; where a single pathologist &#40;JE&#41; provided opinions on cytologies and validated HPV PCR results&#46; Genotypes 16&#44; 18&#44; 26&#44; 31&#44; 33&#44; 35&#44; 39&#44; 45&#44; 51&#8211;53&#44; 56&#44; 58&#44; 59&#44; 66&#44; 68&#44; 73 and 82 were considered high-risk &#40;HR-HPV&#41;&#46; Genotypes 6&#44; 11&#44; 34&#44; 40&#44; 42&#8211;44&#44; 54&#44; 55&#44; 57&#44; 61&#44; 70&#8211;72&#44; 81&#44; 83&#44; 84 and 89 were considered low-risk &#40;LR-HPV&#41;&#46; Viruses 39&#44; 45&#44; 59 and 68 were classified as subspecies of HPV genotype 18&#44; and genotypes 31&#44; 33&#44; 35&#44; 52&#44; 58 and 67 were classified as subspecies of HPV genotype 16&#46;<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">17</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">At the visits &#40;V1 and Vx&#41;&#44; patients with abnormal cytology and&#47;or positive high-risk &#40;HR&#41; HPV PCR underwent high-resolution anoscopy &#40;HRA&#41;&#46; Patients with normal HRA and negative HR-HPV PCR were evaluated every two years with another cytology and PCR&#46; Patients with positive HPV PCR and&#47;or HRA with LSIL &#40;AIN 1&#41; were evaluated every year&#46; Those diagnosed with HSIL or AC were treated &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#46; We developed the follow-up algorithm &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41; based on our own data on sensitivity&#44; specificity and positive and negative predictive values for anal cytology and high-risk HPV PCR to predict HSIL&#46;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">HRA procedures were performed with the Carl Zeiss 150 FC<span class="elsevierStyleSup">&#169;</span> colposcope &#40;Carl Zeiss&#44; Oberkochen&#44; Germany&#41; 4&#8211;12 weeks after anal cytology was done&#46; Prior to HRA&#44; the patient underwent an inspection and a digital rectal examination&#46; After this&#44; a transparent disposable anoscope was inserted&#44; 5<span class="elsevierStyleHsp" style=""></span>ml of acetic acid were instilled through the anoscope and the acetic acid was left in place for around 3<span class="elsevierStyleHsp" style=""></span>min&#46; Next&#44; the anoscope was removed and the mucosa was inspected&#46; After that&#44; Lugol&#39;s 5&#37; solution was instilled and left in place for a minute&#44; and the mucosa was inspected again&#46; Samples were taken both from apparently normal mucosa in the 4 quadrants and from areas suggestive of dysplasia &#40;aceto-white&#47;Lugol&#39;s-negative&#41;&#46; Biopsies were performed with an endoscopic retrograde cholangiopancreatography &#40;ERCP&#41; catheter&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">We used the Bethesda classification for anal and cervical cytology&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">18</span></a> This classification divides lesions into 4 types&#58; atypical squamous cells &#40;ASC&#41;&#44; atypical squamous cells-high &#40;ASC-H&#41; in which high grade cells cannot be ruled out&#44; low-grade squamous intraepithelial lesions &#40;LSIL&#41; and high-grade squamous intraepithelial lesions &#40;HSIL&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The histology classification used for both the anus and the cervix was the &#8220;Squamous Terminology &#40;LAST&#41; Standardisation Project for HPV&#8221; consensus classification&#46; This classifies anal lesions as LSIL &#40;AIN 1&#47;condyloma&#41;&#44; HSIL &#40;AIN 2&#47;AIN 3&#41; or invasive anal canal carcinoma &#40;AC&#41;&#44; and cervical lesions as CIN 1&#44; CIN 2&#44; CIN 3 or CC&#46; P16 was used according to the recommendations of the LAST consensus&#46;<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">19</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">Cytology and histology studies were always performed by the same pathologist &#40;JE&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">At V1 and Vx&#44; the women were referred to a gynaecologist for cervical cytology &#40;the same liquid medium as for anal cytology was used&#41;&#46; If it was abnormal&#44; the women underwent colposcopy with acetic acid and Lugol&#39;s staining&#44; after which only aceto-white Lugol&#39;s-negative areas were biopsied&#46; The samples were sent to the same pathology department&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">Definition of variables&#58;<ul class="elsevierStyleList" id="lis0010"><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">-</span><p id="par0085" class="elsevierStylePara elsevierViewall">Abnormal cytology&#58; cytology featuring ASCUS&#44; ASCUS-H&#44; LSIL or HSIL&#46;</p></li><li class="elsevierStyleListItem" id="lsti0020"><span class="elsevierStyleLabel">-</span><p id="par0090" class="elsevierStylePara elsevierViewall">Histology with HSIL&#43; anal lesion&#58; histology featuring anything from HSIL &#40;AIN 2 or AIN 3&#41; to invasive cancer&#46;</p></li><li class="elsevierStyleListItem" id="lsti0025"><span class="elsevierStyleLabel">-</span><p id="par0095" class="elsevierStylePara elsevierViewall">Histology with LSIL&#43; anal lesion&#58; histology featuring anything from LSIL &#40;condyloma&#47;AIN 1&#41; to invasive cancer&#46;</p></li><li class="elsevierStyleListItem" id="lsti0030"><span class="elsevierStyleLabel">-</span><p id="par0100" class="elsevierStylePara elsevierViewall">Clearance of HR-HPV infection&#58; when a patient having had infection in the anal mucosa with any HR-HPV genotype at the baseline visit &#40;V1&#41; was not found to have any HR-HPV genotype at the last visit&#46;</p></li><li class="elsevierStyleListItem" id="lsti0035"><span class="elsevierStyleLabel">-</span><p id="par0105" class="elsevierStylePara elsevierViewall">Acquisition of HR-HPV infection&#58; when a patient presented a new HR-HPV genotype in the anal mucosa at the last visit that had not been present at the baseline visit &#40;V1&#41;&#46;</p></li></ul></p><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Statistical analysis</span><p id="par0110" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Sample size&#46;</span> We enrolled 95 out of a total of 149 women who received care on the outpatient unit of an infectious disease department belonging to a Spanish tertiary hospital&#46; These women voluntarily agreed to take part in the programme&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Descriptive analysis&#46;</span> We prepared a description of the main variables collected in the study&#44; calculated measures of central tendency and dispersion &#40;mean&#44; standard deviation&#44; median and percentiles&#41; for the quantitative variables&#44; and calculated absolute frequencies with a 95&#37; confidence interval for the qualitative variables&#46; HPV prevalence as well as anal mucosa cytology and histology findings were calculated with a 95&#37; confidence interval&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Bivariate analysis&#46;</span> This was used to examine the relationship between potential risk factors and HR-HPV infection&#46; Student&#39;s <span class="elsevierStyleItalic">t</span> test for independent samples was used for the quantitative variables that followed a normal distribution&#46; The Mann&#8211;Whitney <span class="elsevierStyleItalic">U</span> test was used for those that did not follow such a distribution&#46; Pearson&#39;s chi-squared test was used for the qualitative variables that met the application criteria&#44; and Fisher&#39;s exact test was used for the ones that did not&#46; The Kolmogorov&#8211;Smirnov test was used to confirm whether the different variables fulfilled the hypothesis of normality&#46; A level of significance of 0&#46;05 was applied to all tests&#46; The statistical software programme used was SPSS 20&#46;0&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleItalic">Multivariate analysis&#46;</span> This was performed by means of Poisson regression using the Stata Release 12 statistical software programme with robust error variance and calculating relative risk &#40;RR&#41; as well as its 95&#37; confidence interval&#46; As we performed this type of regression based on the high prevalence of anal infection with HR-HPV in our cohort of HIV-infected women&#44; calculating the RR proved more suitable than calculating the odds ratio&#46; The method of selection of variables was by successive steps backwards&#44; considering a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#60;<span class="elsevierStyleHsp" style=""></span>0&#46;05 to be an entry criterion and a <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#62;<span class="elsevierStyleHsp" style=""></span>0&#46;10 to be an exit criterion&#46; The model included both variables that proved statistically significant in the bivariate analysis and clinically significant variables&#46; It ultimately consisted of the following variables&#58; more than 3 sexual partners throughout life&#44; smoking and abnormal anal and cervical cytology&#46;</p></span></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Results</span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Baseline characteristics of the patients enrolled</span><p id="par0130" class="elsevierStylePara elsevierViewall">We enrolled 95 women with a mean age of 43&#46;7 years &#40;75&#46;8&#37; were 30&#8211;50 years of age&#41;&#46; Their median time since HIV onset was 13&#46;6 years &#40;P25&#8211;P75&#58; 6&#46;8&#8211;21&#46;2&#41;&#44; their nadir CD4 count was 213&#46;7<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;l&#44; 93&#46;6&#37; had been on antiretroviral treatment for 10 years &#40;P25&#8211;P75&#58; 5&#8211;16&#46;8&#41;&#44; their mean CD4 count was 648&#46;7<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;l &#40;CD4&#47;CD8&#58; 0&#46;95&#41; and 7&#46;8&#37; of them were in virologic failure&#46; All other variables are found in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">Of these women&#44; 29&#46;5&#37; had not undergone any type of study&#44; 46&#46;3&#37; had had more than 3 sexual partners throughout life and 28&#46;4&#37; had had anal sex&#46; In addition&#44; 64&#46;2&#37; were smokers&#44; 11&#46;6&#37; had genital&#47;perianal warts and 18&#46;9&#37; had a history of cervical disease &#40;9&#46;5&#37; CIN 1&#44; 6&#46;3&#37; CIN 2&#44; 1&#46;05&#37; CIN 3 and 2&#46;1&#37; CC&#41;&#46; All other variables are presented in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Results of cytologies&#44; biopsies and HPV PCR&#44; baseline visit</span><p id="par0140" class="elsevierStylePara elsevierViewall">Of the HIV&#43;W&#44; 92&#46;6&#37; had a normal cervical cytology&#44; 4&#46;2&#37; had ASCUS&#44; 5&#46;2&#37; had LSIL and 3&#46;2&#37; had HSIL &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; Regarding anal cytology results&#44; we found that 68&#46;4&#37; of patients had normal cytology&#44; 25&#46;3&#37; had LSIL&#44; 2&#46;1&#37; had HSIL and 4&#46;2&#37; had ASCUS &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#44; with statistically significant differences between the two types of cytology &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;0001&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">Regarding the results of anal HPV PCR&#44; 49&#46;4&#37; of women &#40;95&#37; CI&#58; 39&#8211;60&#41; had infection with high-risk genotypes&#44; with a median number of oncogenic genotypes per patient of 0 &#40;P25&#8211;P75&#58; 0&#8211;1&#41;&#59; 40&#37; &#40;95&#37; CI&#58; 29&#8211;51&#41; had infection with low-risk genotypes&#44; with a median of 0 &#40;P25&#8211;P75&#58; 0&#8211;1&#41;&#44; and 31&#37; had simultaneous infection with low- and high-risk genotypes &#40;95&#37; CI&#58; 21&#8211;41&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46; The HPV genotypes most commonly isolated in the anal mucosa were as follows&#58; among low-risk genotypes&#44; 6 &#40;14&#46;3&#37;&#41;&#44; 42 &#40;8&#46;3&#37;&#41;&#44; 62 &#40;7&#46;1&#37;&#41;&#44; 73 &#40;4&#46;8&#37;&#41; and 84 &#40;4&#46;8&#37;&#41;&#44; and&#44; among high-risk genotypes&#44; 16 &#40;19&#37;&#41;&#44; 45 &#40;8&#46;3&#37;&#41;&#44; 51 &#40;8&#46;3&#37;&#41; and 55 &#40;8&#46;3&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">Of the 42 HRA procedures performed&#44; 38&#46;1&#37; were normal&#44; 50&#37; showed LSIL &#40;AIN 1&#41;&#44; 9&#46;5&#37; showed HSIL &#40;AIN 2&#47;3&#41; and 2&#46;4&#37; showed AC &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41;&#46; Of the 12 colposcopies performed&#44; 5&#46;2&#37; were normal&#44; 4&#46;2&#37; were CIN 1&#44; 1&#46;05&#37; were CIN 2&#44; 1&#46;05&#37; were CIN 3 and 1&#46;05&#37; were CC&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0105">Results of follow-up</span><p id="par0155" class="elsevierStylePara elsevierViewall">During the median 36 months &#40;P25&#8211;75&#58; 24&#46;8&#8211;47&#46;3&#41; of follow-up&#44; three women developed new cases of anal HSIL&#44; whose incidence was 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1000 people per year&#46; Of them&#44; 14&#46;8&#37; acquired HR-HPV and 51&#46;2&#37; cleared it&#59; the differences were statistically significant &#40;<span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#41;&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Two women died of their disease&#46; One died of anal cancer 24 months after being diagnosed at the baseline visit and undergoing radiotherapy&#44; chemotherapy and abdominopelvic amputation&#46; The other died of a recurrence of Hodgkin lymphoma&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Of the 8 women with precursor lesions of AC &#40;HSIL&#41; in the cohort&#44; one of them refused to receive treatment&#59; at her 12-month check-up&#44; the lesion &#40;AIN 2&#41; had disappeared and she had LSIL &#40;AIN 1&#41;&#46; Another received intra-anal imiquimod 3 times weekly for 16 weeks&#46; Her disease not only did not respond&#44; but progressed&#44; with greater impairment of quadrants 1&#8211;3&#46; As a result she required electrocauterization&#47;fulguration of her lesions with a scalpel&#46; The remaining 6 women received electrocauterization&#47;fulguration&#46; All 100&#37; of the patients treated did not present precursor lesions or AC again during a median follow-up period of 30&#46;5 months &#40;P25&#8211;P75&#58; 17&#46;5&#8211;36&#46;5&#41;&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">None of the women presented CIN 1&#44; CIN 2&#44; CIN 3 or CC during follow-up&#46; However&#44; 1&#46;05&#37; presented vulvar intraepithelial neoplasia grade 1 &#40;VIN 1&#41; and 1&#46;05&#37; presented VIN 3&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0110">Factors that predict HR-HPV infection</span><p id="par0175" class="elsevierStylePara elsevierViewall">The bivariate analysis found the following to be risk factors for anal infection with HR-HPV&#58; history of sexually transmitted infection &#40;STI&#41; &#40;26&#46;2&#37; vs&#46; 4&#46;7&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;006&#41;&#44; cervical dysplasia &#40;19&#46;1&#37; vs&#46; 0&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;005&#41;&#44; abnormal anal cytology &#40;50&#37; vs&#46; 16&#46;3&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;001&#41; and more than 3 sexual partners throughout life &#40;64&#46;3&#37; vs&#46; 30&#46;2&#37;&#59; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;002&#41;&#46; All other variables may be seen in <a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia><p id="par0180" class="elsevierStylePara elsevierViewall">Finally&#44; the multivariate analysis found the following to be risk factors for anal infection with oncogenic genotypes&#58; smoking &#40;RR&#58; 1&#46;55&#59; 95&#37; CI&#58; 0&#46;99&#8211;2&#46;42&#41;&#44; more than 3 sexual partners throughout life &#40;RR&#58; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;09&#8211;2&#46;62&#41;&#44; cervical dysplasia &#40;RR&#58; 1&#46;83&#59; 95&#37; CI&#58; 1&#46;26&#8211;2&#46;67&#41; and anal dysplasia &#40;RR&#58; 1&#46;55&#59; 95&#37; CI&#58; 1&#46;021&#8211;2&#46;35&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">Table 4</a>&#41;&#46;</p></span></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0115">Discussion</span><p id="par0185" class="elsevierStylePara elsevierViewall">One out of every 10 HIV-positive women in our cohort had a precursor lesion of anal cancer associated with HPV&#44; with an incidence of 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1000 people per year&#44; and up to 50&#37; had a low-grade lesion &#40;LSIL&#47;AIN 1&#41;&#46; A comparative study of seropositive versus seronegative women found a rate of HSIL in HIV-infected women similar to ours &#40;9&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0265"><span class="elsevierStyleSup">20</span></a>&#59; however&#44; it found a much lower prevalence of LSIL &#40;just 12&#37;&#41;&#46; The difference between the results of that study and those of our study could be attributed to the fact that&#44; in that study&#44; anoscopy was performed only in case of abnormal cytology&#46; In our study&#44; based on our own data on the sensitivity of cytology and HPV PCR in screening for HSIL&#44;<a class="elsevierStyleCrossRef" href="#bib0235"><span class="elsevierStyleSup">14</span></a> anoscopy was performed both in women with dysplastic cytology and in women with a positive PCR for any oncogenic genotype of HPV&#46; In another study in HIV&#43;W alone&#44; the rate of HSIL&#43; was 12&#37;&#44; and the main risk factors for this type of lesion were found to be cervical disease and anal infection with genotype 16&#46;<a class="elsevierStyleCrossRef" href="#bib0270"><span class="elsevierStyleSup">21</span></a> However&#44; in a retrospective study consisting of 745 HIV&#43;W&#44; there was a much higher prevalence of HSIL &#40;26&#37;&#41;&#44; which was associated with smoking and abnormal cervical cytology&#46;<a class="elsevierStyleCrossRef" href="#bib0275"><span class="elsevierStyleSup">22</span></a> Finally&#44; a systematic review on precursor lesions of anal cancer associated with HPV in HIV&#43;W showed variability in prevalence figures in these lesions on comparison of different cohorts &#40;from 3&#37; to 26&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> When we compared the prevalence in our cohort of anal HSIL&#43; to cervical HSIL&#43;&#44; we found a higher rate of dysplasia in the anus&#44; with statistically significant differences&#46; Moreover&#44; for the median follow-up period of 3 years&#44; we found no cases of a cervical precursor lesion or cervical cancer&#46; These results were consistent with those reported to date in the literature&#44; in which the incidence of CC has been gradually reducing in cohorts of HIV-infected women thanks in part to the introduction of antiretroviral treatment&#46;<a class="elsevierStyleCrossRef" href="#bib0280"><span class="elsevierStyleSup">23</span></a></p><p id="par0190" class="elsevierStylePara elsevierViewall">Regarding anal cancer&#44; the prevalence that we discovered in our cohort was much the same as that of CC &#40;lower than 3&#37; in both cases&#41;&#46; In the median 36 months of follow-up&#44; none of the women presented anogenital cancer again&#44; and those who were diagnosed with and treated for a precursor lesion associated with HPV also did not experience progression to AC&#46; One of them&#44; who had anal HSIL&#44; even experienced spontaneous remission&#46; This could be due&#44; among other reasons&#44; to the fact that more than 90&#37; were undergoing antiretroviral treatment and had an excellent viro-immunological status&#46; A meta-analysis in seropositive patients on anal infection with HPV and neoplastic lesions associated with this infection found that anal intraepithelial neoplasia progressed to anal cancer at a lower rate than CIN 3 progressed to cervical cancer &#40;1 in 600&#215; year in men who have sex with men who are seropositive vs&#46; 1 in 80&#215; year in women&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">24</span></a></p><p id="par0195" class="elsevierStylePara elsevierViewall">AC is a non-AIDS-defining disease that is highly prevalent in the HIV-positive population versus the general population&#46;<a class="elsevierStyleCrossRef" href="#bib0290"><span class="elsevierStyleSup">25</span></a> A variable incidence from 3&#46;9 to 30<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>100&#44;000 people per year has been reported in HIV-infected women&#46; These figures are as high as 63&#46;8 cases per 100&#44;000 people per year in those with CC or CIN 3&#46;<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">2</span></a> Recent publications on cohorts of HIV-infected patients who were men who had sex with men have reported a protective effect of ART against the development of precursor lesions and AC associated with HPV<a class="elsevierStyleCrossRefs" href="#bib0210"><span class="elsevierStyleSup">9&#8211;11&#44;26&#44;27</span></a>&#59; this could account for our findings&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Regarding the prevalence of HPV infection of the anal mucosa in the women we studied&#44; we found that as many as half of them were infected with high-risk genotypes&#44; 2&#47;5 were infected with low-risk genotypes and 1&#47;3 were infected with both genotypes&#46; HPV genotype 16 was the most commonly isolated genotype in the anal mucosa&#44; having been isolated in nearly one out of every five patients&#46; Genotype 6 was the most commonly isolated low-risk genotype&#46; A recently published study on HPV prevalence in HIV&#43;W showed that approximately half of patients were infected with oncogenic genotypes&#44; the most common one being 16&#59; these data are very similar to our study&#39;s data&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> The SUN prospective cohort study&#44; consisting of 120 HIV&#43;W&#44; found a prevalence of 85&#37; of these genotypes in the anus&#46; That study may have differed from our data and prior data<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> in part because its cohort&#44; compared to ours&#44; had a lower percentage of patients in antiretroviral treatment &#40;ART&#41;&#44; in virologic suppression and with CD4 counts &#62;500<span class="elsevierStyleHsp" style=""></span>cells&#47;ml &#40;just 77&#37;&#44; 73&#37; and 36&#37;&#44; respectively&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0310"><span class="elsevierStyleSup">29</span></a></p><p id="par0205" class="elsevierStylePara elsevierViewall">We also found that one out of every 7 women acquired high-risk genotypes&#44; and although more than half cleared them during follow-up&#44; the incidence of anal HSIL in our cohort was high&#46; A retrospective study by the AIDS Clinical Trials Group &#40;ACTG&#41; &#40;A5029&#41; showed that HIV&#43;W on antiretroviral treatment with a CD4 count &#62;350<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;l had a higher rate of clearance and&#44; in the case of an HIV viral load &#62;400<span class="elsevierStyleHsp" style=""></span>copies&#47;ml&#44; a higher rate of acquisition&#46;<a class="elsevierStyleCrossRef" href="#bib0315"><span class="elsevierStyleSup">30</span></a> These data could account for our results&#44; since 93&#46;6&#37; of our patients received ART&#44; our patients had a mean CD4 count of 648&#46;7<span class="elsevierStyleHsp" style=""></span>cells&#47;&#956;l and just 7&#46;8&#37; were found to be in virologic failure&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">When we analysed potential predictive factors for infection of the anal mucosa with oncogenic genotypes&#44; we discovered that those with a statistically significant link were smoking&#44; more than three sexual partners throughout life&#44; cervical dysplasia and anal dysplasia&#46; These data were consistent with those reported in 2016 by the ANRS-C017 VIHGY study group&#44; who found the following to be factors associated with anal infection with oncogenic viruses in HIV&#43;W&#58; dysplastic cervical cytology&#44; cervical infection with high-risk HPV and CD4 &#60;350<span class="elsevierStyleHsp" style=""></span>cells&#47;ml&#46; This cohort had rates of ART and CD4 &#62;500<span class="elsevierStyleHsp" style=""></span>cells&#47;ml close to 100&#37;&#44; and more than 80&#37; of patients were found to be in virologic suppression&#46;<a class="elsevierStyleCrossRef" href="#bib0305"><span class="elsevierStyleSup">28</span></a> Smoking in HIV-positive patients has also been previously linked to dysplasia of the anal canal&#44;<a class="elsevierStyleCrossRef" href="#bib0320"><span class="elsevierStyleSup">31</span></a> as well as infection with a high-risk virus in the cervix and CIN 2&#43; lesions in HIV&#43;W&#46;<a class="elsevierStyleCrossRef" href="#bib0325"><span class="elsevierStyleSup">32</span></a> Regarding sexual habits&#44; both the type of relationship and a higher number of sexual partners have been considered to be classic factors in infection with oncogenic HPV in the anal mucosa&#46;<a class="elsevierStyleCrossRef" href="#bib0330"><span class="elsevierStyleSup">33</span></a></p><p id="par0215" class="elsevierStylePara elsevierViewall">One of the main limitations of our study lay in its single-centre design&#46; Other limitations derived from the fact that we did not have access to PCR for HPV from the cervix &#40;due to problems beyond the control of the researchers and related to budget constraints&#41;&#44; and still others were related to the exclusion criteria&#46; The strengths of the study included its longitudinal and prospective design&#59; the fact that the patients always received care from the same clinic which was responsible for taking samples as well as HRA&#59; and the fact that cytology and histology were interpreted by the same pathologist&#46;</p><p id="par0220" class="elsevierStylePara elsevierViewall">In conclusion&#44; in this late period of antiretroviral therapy&#44; the prevalence and incidence of precursor lesions for anal cancer associated with HPV in our cohort of HIV&#43;W were higher than those for cervical cancer&#44; despite the fact that clearance of oncogenic genotypes in the anal mucosa exceeded acquisition&#46; Therefore&#44; we believe that screening for these lesions should be offered to all HIV-infected women&#44; with special emphasis on &#40;in no particular order&#41; those who smoke&#44; those who have a higher number of sexual partners and those with anogenital dysplasia&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0120">Conflicts of interest</span><p id="par0225" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflicts of interest&#46;</p></span></span>"
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              "titulo" => "Baseline characteristics of the patients enrolled"
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              "titulo" => "Results of cytologies&#44; biopsies and HPV PCR&#44; baseline visit"
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            0 => "High-risk human papillomavirus"
            1 => "Women living with HIV"
            2 => "Cervical cancer"
            3 => "Anal cancer"
            4 => "Anal cancer precursor lesions"
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            0 => "Virus del papiloma humano de alto riesgo"
            1 => "Mujeres seropositivas"
            2 => "C&#225;ncer de c&#233;rvix"
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        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Anal cancer is one of the most common non-AIDS defining malignancies&#44; especially in men who have sex with men and women living with HIV &#40;WLHIV&#41;&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objectives</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">To evaluate the prevalence and incidence of precursor lesions &#40;high-grade squamous intraepithelial lesions &#91;HSIL&#93;&#41; and anal cancer in our cohort of women and to compare them to cervical lesions&#59; to calculate the percentage of patients that acquire and clear oncogenic genotypes &#40;HR-HPV&#41; in the anal canal&#59; and to determine predictive factors for anal HPV infection&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Patients and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Prospective-longitudinal study &#40;May 2012&#8211;December 2016&#41;&#46; At baseline &#40;V1&#41; and follow up visits&#44; anal mucosa samples were taken in liquid medium for cytology and HPV PCR&#46; In cases of abnormal anal cytology and&#47;or positive HR-HPV PCR results&#44; a high resolution anoscopy was performed&#46; Patients were also referred to the gynaecologist&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Ninety five women with an average age of 43&#46;7 years were included&#46; At baseline&#44; 11&#46;6&#37; had cervical abnormalities &#40;4&#46;1&#37; CIN1&#44; 2&#46;2&#37; CIN2&#47;3&#44; 1&#46;1&#37; cervical cancer&#41;&#44; 64&#46;3&#37; anal abnormalities &#40;50&#37; LSIL&#47;AIN1&#44; 9&#46;5&#37; HSIL&#47;AIN2&#47;3 and 2&#46;4&#37; anal cancer&#41; and 49&#46;4&#37; had HR-HPV genotypes&#46; During 36 months of follow up&#44; the incidence of anal HSIL was 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1000 person-years&#59; 14&#46;8&#37; acquired HR-HPV genotypes and 51&#46;2&#37; cleared them&#44; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#46;007&#46; No patients presented CIN1&#47;2&#47;3&#47; or cervical cancer&#46; In the multivariate analysis we found the following predictive factors for HR-HPV infection&#58; smoking &#40;RR&#58; 1&#46;55&#44; 95&#37; CI&#58; 0&#46;99&#8211;2&#46;42&#41;&#44; number of sexual partners &#62;3 &#40;RR&#58; 1&#46;69&#59; 95&#37; CI&#58; 1&#46;09&#8211;2&#46;62&#41;&#44; cervical and anal dysplasia &#40;RR&#58; 1&#46;83&#59; 95&#37; CI&#58; 1&#46;26&#8211;2&#46;67&#41; and &#40;RR&#58; 1&#46;55&#59; 95&#37; CI&#58; 1&#46;021&#8211;2&#46;35&#41;&#44; respectively&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Despite clearance rates of anal oncogenic genotypes being higher than acquisition rates&#44; prevalence and incidence of HSIL were still high and greater than cervical HSIL&#46; Therefore&#44; screening for these lesions should perhaps be offered to all WLHIV&#46;</p></span>"
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            "titulo" => "Introduction"
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            "titulo" => "Objectives"
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          2 => array:2 [
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        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El c&#225;ncer de ano &#40;CA&#41; es uno de los tumores no definitorios de sida m&#225;s frecuentes&#44; principalmente en hombres que tienen sexo con hombres y mujeres infectadas por VIH&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Objetivos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Evaluar la prevalencia e incidencia de lesiones precursoras &#40;HSIL&#41; y CA en nuestra cohorte de mujeres&#44; y compararlas con las de c&#233;rvix&#59; analizar el porcentaje de pacientes que adquieren y aclaran genotipos oncog&#233;nicos &#40;VPH-AR&#41; del canal anal&#59; y los factores predictores para dicha infecci&#243;n en ano&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Paciente y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Estudio prospectivo-longitudinal &#40;mayo de 2012-diciembre de 2016&#41;&#46; En visita basal &#40;V1&#41; y posteriores se tomaban muestras de mucosa anal en medio l&#237;quido para citolog&#237;a&#44; y PCR del VPH&#46; En caso de citolog&#237;a anal patol&#243;gica y&#47;o PCR del VPH-AR positiva se realizaba anoscopia de alta resoluci&#243;n&#46; Adem&#225;s&#44; se enviaban al ginec&#243;logo&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Noventa y cinco mujeres de 43&#44;7<span class="elsevierStyleHsp" style=""></span>a&#241;os fueron incluidas&#46; En V1&#44; el 11&#44;6&#37; ten&#237;an patolog&#237;a cervical &#40;4&#44;1&#37; CIN1&#59; 2&#44;2&#37; CIN2&#47;3&#59; 1&#44;1&#37; c&#225;ncer de c&#233;rvix &#91;<span class="elsevierStyleSmallCaps">CC</span>&#93;&#41;&#59; el 64&#44;3&#37; presentaban patolog&#237;a anal &#40;50&#37; LSIL&#47;AIN1&#44; 9&#44;5&#37; HSIL&#47;AIN2&#47;3 y 2&#44;4&#37; CA&#41; y el 49&#44;4&#37;&#44; infecci&#243;n por VPH-AR&#46; Durante 36<span class="elsevierStyleHsp" style=""></span>meses de seguimiento la incidencia de HSIL anal fue de 16<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>1&#46;000 persona-a&#241;o&#59; el 14&#44;8&#37; adquirieron VPH-AR y el 51&#44;2&#37; los aclararon&#44; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;007&#59; ninguna present&#243; CIN1&#47;2&#47;3 o CC&#46; En el an&#225;lisis multivariante encontramos como factores predictores de infecci&#243;n por VPH-AR&#58; tabaquismo &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 0&#44;99-2&#44;42&#41;&#44; n&#250;mero de parejas sexuales &#62;<span class="elsevierStyleHsp" style=""></span>3 &#40;RR&#58; 1&#44;69&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;09-2&#44;62&#41;&#44; displasia cervical &#40;RR&#58; 1&#44;83&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;26-2&#44;67&#41; y anal &#40;RR&#58; 1&#44;55&#59; IC<span class="elsevierStyleHsp" style=""></span>95&#37;&#58; 1&#44;021-2&#44;35&#41;&#46;</p></span> <span id="abst0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">A pesar de que el aclaramiento de genotipos oncog&#233;nicos en ano era mayor que la adquisici&#243;n&#44; la prevalencia e incidencia de HSIL era elevada&#44; y superior a la de c&#233;rvix&#44; por lo que quiz&#225; deber&#237;a ofertarse el cribado de dichas lesiones a todas las mujeres seropositivas&#46;</p></span>"
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        "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as&#58; Hidalgo-Tenorio C&#44; de Jesus SE&#44; Esquivias J&#44; Pasquau J&#46; Alta prevalencia e incidencia de lesiones precursoras de c&#225;ncer anal asociada a la infecci&#243;n por VPH en mujeres VIH positivas en la era tard&#237;a del TAR&#46; Enferm Infecc Microbiol Clin&#46; 2018&#59;36&#58;555&#8211;562&#46;</p>"
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          "en" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Follow-up algorithm&#46; HRA&#58; high-resolution anoscopy&#59; AIN&#58; anal intraepithelial neoplasm&#59; ASC&#58; atypical squamous cells&#59; AC&#58; anal cancer&#59; HSIL&#58; high-grade intraepithelial lesion&#59; LSIL&#58; low-grade intraepithelial lesion&#59; HPV PCR&#58; human papilloma virus protein chain reaction&#46;</p>"
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          "en" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Flow of patients from anal cytology and HR-HPV PCR to HRA&#46;</p> <p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">HRA&#58; high-resolution anoscopy&#59; AIN&#58; anal intraepithelial neoplasm&#59; ASCUS&#58; atypical squamous cells of undetermined significance&#59; AC&#58; anal cancer&#59; HSIL&#58; high-grade intraepithelial lesion&#59; LSIL&#58; low-grade intraepithelial lesion&#59; HPV PCR&#58; human papilloma virus protein chain reaction&#46;</p>"
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">VL&#58; HIV viral load&#59; FPDA&#58; former parenteral drug addiction&#59; STI&#58; sexually transmitted infection&#59; HIV&#43;W&#58; HIV-positive women&#59; HBV&#58; chronic hepatitis B infection&#59; HCV&#58; chronic hepatitis C infection&#59; SDU&#58; standard drink unit&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HIV&#43;W &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;7 &#40;&#177;8&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;30 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;30&#8211;50 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;75&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;17&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chronic HCV infection&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">24 &#40;25&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Chronic HBV infection&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">History of anal&#47;genital condyloma&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;34&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anal&#47;genital condyloma at baseline visit</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">History of STI&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;15&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">History of cervical disease&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;9&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;6&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cervical cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Smoking&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">61 &#40;64&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">FPDA&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;22&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Alcohol use&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;14&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Alcohol &#40;SDUs&#41; &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">95</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Form of HIV acquisition&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Heterosexual&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">72 &#40;75&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>FPDA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;22&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Vertical&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Unknown&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time since HIV onset &#40;years&#41; &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13&#46;6 &#40;6&#46;8&#8211;21&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 at HIV diagnosis &#40;cells&#47;&#956;l&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">362&#46;6 &#40;&#177;315&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nadir CD4 count &#40;cells&#47;ul&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">213&#46;7 &#40;&#177;172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nadir CD4 count &#60;200</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cells&#47;&#956;l&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">46 &#40;48&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 at baseline visit &#40;cells&#47;&#956;l&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">645&#46;6 &#40;&#177;372&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD8 at baseline visit &#40;cells&#47;&#956;l&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">797&#46;6 &#40;&#177;361&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HIV VL at baseline visit &#40;log&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;8 &#40;&#177;4&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prior history of AIDS&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">49 &#40;51&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">89 &#40;93&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Virologic failure&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Median months of ART &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95&#46;5 &#40;18&#8211;172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Variables&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Level of education</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>No primary studies&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;29&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Primary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">40 &#40;42&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Secondary&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">20 &#40;21&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>University&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;7&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Retired&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;26&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Origin&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Europe&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">81 &#40;85&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Africa&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;11&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Other&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age of sexual debut &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17&#46;2 &#40;&#177;3&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex in the past 12 months&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">66 &#40;69&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Median sexual partners throughout life &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;2&#8211;10&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#37; of patients with &#62;3 sexual partners throughout life&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44 &#40;46&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Median sexual partners in the past 12 months &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anal sex&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;28&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Normally uses a condom&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">35 &#40;53&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab1882738.png"
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          "en" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Demographic characteristics and characteristics related to sexual habits&#46;</p>"
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      5 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at3"
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          "leyenda" => "<p id="spar0095" class="elsevierStyleSimplePara elsevierViewall">CIN&#58; cervical intraepithelial neoplasia&#59; HPV&#58; human papilloma virus&#59; HR-HPV&#58; high-risk HPV&#44; LR-HPV&#58; low-risk HPV&#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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">HIV&#43;W &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>95&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Cervical cytology&#44; n &#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Normal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">88 &#40;92&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>ASCUS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LSIL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;5&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HSIL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;3&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">Colposcopy&#44; n&#40;&#37;&#41;</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4 &#40;4&#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="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>CIN 3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Cervical cancer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#46;05&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="2" align="left" valign="top"><span class="elsevierStyleItalic">HPV PCR</span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HR-HPV&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">42 &#40;49&#46;4&#41; &#91;39&#8211;60&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>LR-HPV&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;40&#41; &#91;29&#8211;51&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>HR-HPV and LR-HPV&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41; &#91;95&#37; CI&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">26 &#40;31&#41; &#91;21&#8211;41&#93;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median HR-HPV &#40;P<span class="elsevierStyleInf">25</span>&#8211;P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Median LR-HPV &#40;P<span class="elsevierStyleInf">25</span>&#8211;P<span class="elsevierStyleInf">75</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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          "en" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">Results of cervical cytology&#44; colposcopy and HPV PCR of the anal mucosa&#46;</p>"
        ]
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      6 => 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"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">VL&#58; viral load&#59; STI&#58; sexually transmitted infection&#59; RR&#58; relative risk&#59; HPV&#58; human papilloma 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="table-head  " align="" valign="top" scope="col" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">With HR-HPV &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>42&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Without HR-HPV &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>43&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Bivariate&#58; <span class="elsevierStyleItalic">p</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th><th class="td" title="table-head  " align="left" valign="top" scope="col" style="border-bottom: 2px solid black">Multivariate&#58; RR 95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Mean age &#40;years&#41;&#44; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">44&#46;5 &#40;&#177;7&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">43&#46;4 &#40;&#177;8&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#60;30 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>30&#8211;50 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">34 &#40;79&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>&#62;50 years&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">10 &#40;23&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Retired&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;30&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;25&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anal sex&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">15 &#40;35&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;25&#46;6&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;47&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sex in the past 12 months&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">28 &#40;66&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">31 &#40;72&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexual partners in the past 12 months &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;0&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;1&#8211;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;77&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Sexual partners throughout life &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;3&#8211;20&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;5 &#40;1&#46;7&#8211;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;69 &#40;1&#46;09&#8211;2&#46;62&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">&#37; with &#62;3 sexual partners&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">27 &#40;64&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">13 &#40;30&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Age of sexual debut &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">P75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;15&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;16&#8211;18&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;096&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Uses a condom&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">17 &#40;40&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">16 &#40;37&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;83 &#40;1&#46;25&#8211;2&#46;57&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Genital&#47;anal warts&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">3 &#40;6&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;09&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;55 &#40;1&#46;02&#8211;2&#46;35&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prior cervical dysplasia</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">9 &#40;21&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">6 &#40;13&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Current cervical cytology abnormal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">8 &#40;19&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;005&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Anal mucosa cytology abnormal</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;50&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">7 &#40;16&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Prior history of&#58;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>STI&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">11 &#40;26&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2 &#40;4&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;006&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleHsp" style=""></span>Smoking&#44; <span class="elsevierStyleItalic">n</span> &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">30 &#40;71&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;53&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;08&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1&#46;55 &#40;0&#46;99&#8211;2&#46;44&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="table-entry  " colspan="5" align="left" valign="top"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Time since HIV onset &#40;months&#41; &#40;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">25</span></span><span class="elsevierStyleItalic">&#8211;P</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">75</span></span><span class="elsevierStyleItalic">&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">180 &#40;36&#8211;264&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">153 &#40;67&#46;2&#8211;245&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 on HIV diagnosis &#40;cells&#47;ul&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">359&#46;7 &#40;&#177;274&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">349&#46;5 &#40;&#177;362&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nadir CD4 count &#40;cells&#47;ul&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">210&#46;3 &#40;&#177;190&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">199&#46;9 &#40;&#177;162&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Nadir CD4 count &#60;200</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">cells&#47;&#956;l</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">23 &#40;54&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">21 &#40;48&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4 &#40;cells&#47;&#956;l&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">559&#46;9 &#40;&#177;39&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">710&#46;5 &#40;&#177;364&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD8 &#40;cells&#47;&#956;l&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">733 &#40;&#177;290&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">880&#46;6 &#40;&#177;430&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;07&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">CD4&#47;CD8&#44; cells&#47;&#956;l &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;91 &#40;&#177;0&#46;72&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;96 &#40;&#177;0&#46;58&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">HIV VL &#40;log&#41; &#40;&#177;SD&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">4&#46;4 &#40;&#177;4&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">2&#46;3 &#40;&#177;2&#46;99&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">VL &#60;50</span><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">copies&#47;ml&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">32 &#40;76&#46;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;88&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;14&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">AIDS stage &#40;A3&#44; B3 or C&#41;&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">25 &#40;59&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">22 &#40;51&#46;2&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;44&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">ART&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">38 &#40;90&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">41 &#40;95&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;43&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Median months of ART &#40;P25&#8211;P75&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">95 &#40;8&#8211;172&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">83&#46;5 &#40;24&#8211;154&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="table-entry ; entry_with_role_rowhead " align="left" valign="top"><span class="elsevierStyleItalic">Virologic failure&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">5 &#40;11&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">1 &#40;2&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="char" valign="top">0&#46;10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="table-entry  " align="" valign="top">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
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Article information
ISSN: 2529993X
Original language: English
DOI:10.1016/j.eimce.2018.07.003
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