Brief report
Missed opportunities in the early detection of HIV infection in patients with sexually transmitted infections: A real-life study
Oportunidades perdidas en la detección temprana de la infección por VIH en pacientes con infecciones de transmisión sexual: un estudio de vida real
Read
74
Timeswas read the article
7
Total PDF
67
Total HTML
Share statistics
array:25 [ "pii" => "S2529993X24000108" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2024.01.004" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "2744" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "copyrightAnyo" => "2023" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:146-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S0213005X23001921" "issn" => "0213005X" "doi" => "10.1016/j.eimc.2023.08.003" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "2744" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:146-8" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "es" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original breve</span>" "titulo" => "Oportunidades perdidas en la detección temprana de la infección por VIH en pacientes con infecciones de transmisión sexual: un estudio de vida real" "tienePdf" => "es" "tieneTextoCompleto" => "es" "tieneResumen" => array:2 [ 0 => "es" 1 => "en" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "146" "paginaFinal" => "148" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Missed opportunities in the early detection of HIV infection in patients with sexually transmitted infections: A real-life study" ] ] "contieneResumen" => array:2 [ "es" => true "en" => true ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1323 "Ancho" => 1508 "Tamanyo" => 104066 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Flujo de pacientes en el estudio.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José Ma. García de Lomas-Guerrero, Nicolás Jiménez-García, Fernando Fernández-Sánchez, Alfonso del Arco-Jiménez, José Luis Prada-Pardal, Javier de la Torre-Lima" "autores" => array:6 [ 0 => array:2 [ "nombre" => "José Ma." "apellidos" => "García de Lomas-Guerrero" ] 1 => array:2 [ "nombre" => "Nicolás" "apellidos" => "Jiménez-García" ] 2 => array:2 [ "nombre" => "Fernando" "apellidos" => "Fernández-Sánchez" ] 3 => array:2 [ "nombre" => "Alfonso" "apellidos" => "del Arco-Jiménez" ] 4 => array:2 [ "nombre" => "José Luis" "apellidos" => "Prada-Pardal" ] 5 => array:2 [ "nombre" => "Javier" "apellidos" => "de la Torre-Lima" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2529993X24000108" "doi" => "10.1016/j.eimce.2024.01.004" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X24000108?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23001921?idApp=UINPBA00004N" "url" => "/0213005X/0000004200000003/v1_202403031059/S0213005X23001921/v1_202403031059/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2529993X23001120" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2023.01.007" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "2693" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:149-51" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Bacteremia due to <span class="elsevierStyleItalic">Leuconostoc</span> species: A 13-year single-center case series" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "149" "paginaFinal" => "151" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Bacteriemia por <span class="elsevierStyleItalic">Leuconostoc</span> spp.: serie de casos en un hospital de tercer nivel a lo largo de 13 años" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "José María Caso, Raúl Recio, María Ruiz-Ruigómez, María Ángeles Orellana, Mario Fernández-Ruiz" "autores" => array:5 [ 0 => array:2 [ "nombre" => "José María" "apellidos" => "Caso" ] 1 => array:2 [ "nombre" => "Raúl" "apellidos" => "Recio" ] 2 => array:2 [ "nombre" => "María" "apellidos" => "Ruiz-Ruigómez" ] 3 => array:2 [ "nombre" => "María Ángeles" "apellidos" => "Orellana" ] 4 => array:2 [ "nombre" => "Mario" "apellidos" => "Fernández-Ruiz" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0213005X23000137" "doi" => "10.1016/j.eimc.2023.01.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23000137?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X23001120?idApp=UINPBA00004N" "url" => "/2529993X/0000004200000003/v1_202403030914/S2529993X23001120/v1_202403030914/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2529993X24000388" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2023.12.001" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "2773" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:140-5" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:12 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Original article</span>" "titulo" => "Effectiveness of influenza vaccine in preventing severe cases of influenza: Season 2022/2023" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "140" "paginaFinal" => "145" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Efectividad de la vacuna antigripal para prevenir casos graves de gripe. Temporada 2022/2023" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Guillermo Platas-Abenza, María Guerrero-Soler, Raissa de Fatima Silva-Afonso, Pilar Gallardo-Rodriguez, Francisco Gil-Sánchez, Isabel Escribano-Cañadas, Carmen M. Benito-Miralles, Noemi Solis-Aniorte, Rocio Carnicer-Bueno, Ana Esclapez-Martínez, Pablo Chico-Sánchez, José Sánchez-Payá, Paula Gras-Valentí" "autores" => array:13 [ 0 => array:2 [ "nombre" => "Guillermo" "apellidos" => "Platas-Abenza" ] 1 => array:2 [ "nombre" => "María" "apellidos" => "Guerrero-Soler" ] 2 => array:2 [ "nombre" => "Raissa de Fatima" "apellidos" => "Silva-Afonso" ] 3 => array:2 [ "nombre" => "Pilar" "apellidos" => "Gallardo-Rodriguez" ] 4 => array:2 [ "nombre" => "Francisco" "apellidos" => "Gil-Sánchez" ] 5 => array:2 [ "nombre" => "Isabel" "apellidos" => "Escribano-Cañadas" ] 6 => array:2 [ "nombre" => "Carmen M." "apellidos" => "Benito-Miralles" ] 7 => array:2 [ "nombre" => "Noemi" "apellidos" => "Solis-Aniorte" ] 8 => array:2 [ "nombre" => "Rocio" "apellidos" => "Carnicer-Bueno" ] 9 => array:2 [ "nombre" => "Ana" "apellidos" => "Esclapez-Martínez" ] 10 => array:2 [ "nombre" => "Pablo" "apellidos" => "Chico-Sánchez" ] 11 => array:2 [ "nombre" => "José" "apellidos" => "Sánchez-Payá" ] 12 => array:2 [ "nombre" => "Paula" "apellidos" => "Gras-Valentí" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0213005X23002422" "doi" => "10.1016/j.eimc.2023.12.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0213005X23002422?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X24000388?idApp=UINPBA00004N" "url" => "/2529993X/0000004200000003/v1_202403030914/S2529993X24000388/v1_202403030914/en/main.assets" ] "asociados" => array:1 [ 0 => array:18 [ "pii" => "S2529993X24000613" "issn" => "2529993X" "doi" => "10.1016/j.eimce.2024.01.013" "estado" => "S300" "fechaPublicacion" => "2024-03-01" "aid" => "2786" "copyright" => "Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "edi" "cita" => "Enferm Infecc Microbiol Clin. 2024;42:121-3" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial</span>" "titulo" => "Missed opportunities in HIV diagnosis: A need to close the gap" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "121" "paginaFinal" => "123" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oportunidades perdidas en el diagnóstico del VIH: es tiempo de actuar" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Federico García, Ma José Pena, Juan González del Castillo" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Federico" "apellidos" => "García" ] 1 => array:2 [ "nombre" => "Ma José" "apellidos" => "Pena" ] 2 => array:2 [ "nombre" => "Juan" "apellidos" => "González del Castillo" ] ] ] ] ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X24000613?idApp=UINPBA00004N" "url" => "/2529993X/0000004200000003/v1_202403030914/S2529993X24000613/v1_202403030914/en/main.assets" ] ] "en" => array:19 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Brief report</span>" "titulo" => "Missed opportunities in the early detection of HIV infection in patients with sexually transmitted infections: A real-life study" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "146" "paginaFinal" => "148" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "José M.a García de Lomas-Guerrero, Nicolás Jiménez-García, Fernando Fernández-Sánchez, Alfonso del Arco-Jiménez, José Luis Prada-Pardal, Javier de la Torre-Lima" "autores" => array:6 [ 0 => array:3 [ "nombre" => "José M.a" "apellidos" => "García de Lomas-Guerrero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:4 [ "nombre" => "Nicolás" "apellidos" => "Jiménez-García" "email" => array:1 [ 0 => "nijimenez93@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 2 => array:3 [ "nombre" => "Fernando" "apellidos" => "Fernández-Sánchez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Alfonso" "apellidos" => "del Arco-Jiménez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:3 [ "nombre" => "José Luis" "apellidos" => "Prada-Pardal" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 5 => array:3 [ "nombre" => "Javier" "apellidos" => "de la Torre-Lima" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Medicina Interna, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Microbiología, Hospital Costa del Sol, Marbella, Málaga, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Oportunidades perdidas en la detección temprana de la infección por VIH en pacientes con infecciones de transmisión sexual: un estudio de vida real" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1323 "Ancho" => 1508 "Tamanyo" => 120940 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of study patients.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Reducing late diagnosis of HIV infection is one of the main challenges to ending acquired immunodeficiency syndrome (AIDS).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The established definition of diagnostic delay refers to people with a CD4 cell count below 350 cells/μl at diagnosis, or who have an AIDS-defining event, regardless of CD4 cell count.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Early diagnosis of HIV infection has clear benefits for the individual and the community by reducing both morbidity and mortality rates among those affected, as well as by changing behaviours that promote transmission.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In Spain there are an estimated 150,000 people living with HIV infection, an overall prevalence in the Spanish adult population of four per 1000.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a> The available data suggest that 7.5% of them are unaware of their status.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Moreover, 45.9% of people diagnosed for the first time in 2019 showed signs of late diagnosis.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Early detection is possible, partly because HIV testing here in Spain is free and confidential for all.</p><p id="par0015" class="elsevierStylePara elsevierViewall">As a result of the European HIDES-2<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> project, a guide for HIV testing based on HIV-indicative conditions was developed in Spain in 2013, and in 2014 the Spanish National AIDS Plan published the Recommendation Guidelines for the early diagnosis of HIV in the healthcare setting.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> It lists a number of HIV indicator diseases associated with an undiagnosed HIV prevalence >0.1% and other diseases possibly associated with an undiagnosed HIV prevalence >0.1%. The guidelines recommend HIV testing for these patients, in addition to those with AIDS-defining illnesses.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">November 2012 saw publication of the Spanish National AIDS Plan Secretariat/SEMES [Spanish Society of Emergency Medicine]/GESIDA [AIDS Study Group] Consensus Document on Emergencies and HIV,<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> which lists a number of situations in which the prevalence of HIV infection may be higher than 1% and a diagnostic test for HIV-1 infection may be advisable, unless there are other reasons to explain the diagnosis (apart from those defining AIDS). Both documents include some sexually transmitted infections (STI), such as syphilis, urethritis and infection with viruses such as herpes simplex, as indicators of HIV infection.<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8,9</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">If any of these conditions are suspected clinically, HIV testing should be requested. This study evaluates the degree of clinical compliance with these recommendations in real-life situations in a second-level hospital over the period of a year. The main objective was to analyse requests for HIV serology in patients with suspected STI and estimate the number of missed opportunities for diagnosis (MOD) for early diagnosis of HIV.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Material and methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">Retrospective cross-sectional descriptive study under real-life conditions. We analysed all patients treated in the health area of the Costa del Sol hospital in Marbella in 2018 whose doctor requested a PCR for <span class="elsevierStyleItalic">Chlamydia trachomatis</span>, <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> or <span class="elsevierStyleItalic">Trichomonas vaginalis</span>. Patients with known HIV infection were excluded. Of the remaining patients, we studied how many had been tested for HIV serology at the same time. Of the serologies performed (Atellica® IM EHIV reagent Kit, Siemens), we analysed the number of positive results and whether or not they were subsequently confirmed by Line Immunoassay (LIA) (INNO-LIA HIV I/II Score, Fujirebio) (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">Descriptive analysis was performed by presenting frequencies and percentages of qualitative study variables (sample origin, pathogen identification, HIV serology yes/no, HIV positive/negative serology) using SPSS 23.0.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Results</span><p id="par0040" class="elsevierStylePara elsevierViewall">A total of 2258 requests for PCR tests for <span class="elsevierStyleItalic">C. trachomatis</span> and <span class="elsevierStyleItalic">N. gonorrhoeae</span> had been made for 1896 patients. Of these samples, 139 (6.16%) were from anal swabs, 1327 (58.77%) cervical, 16 (0.71%) ear/nose/throat and 776 (34.36%) urethral;</p><p id="par0045" class="elsevierStylePara elsevierViewall">5.27% of the samples did not arrive properly at the laboratory, due to problems with the sampling conditions, the medium or loss in transit. Of the 2141 samples processed, 85.84% were pathogen-free, 12.2% were pathogenic, and 42 (1.96%) undetermined. In 169 (7.89%) samples <span class="elsevierStyleItalic">C. trachomatis</span> was detected, 68 (3.18%) samples were positive for <span class="elsevierStyleItalic">N. gonorrhoeae</span> and in 22 cases (1.03%) <span class="elsevierStyleItalic">T. vaginalis</span> was detected.</p><p id="par0050" class="elsevierStylePara elsevierViewall">Of the 1896 patients, 78 had known HIV infection. Of the remaining 1818, HIV serology was performed on 44.66%, while the rest were MOD. Among the 812 serologies performed, 1.48% were positive for HIV, all of which were confirmed by Line Immunoassay (LIA). Of the positive serologies, the mean CD4 level was 566.76 cells per microlitre, with only two patients in the late diagnosis range (<350 CD4 cells per microlitre): 257.41 and 235.33 cells per microlitre respectively.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Discussion</span><p id="par0055" class="elsevierStylePara elsevierViewall">At our centre, 12.1% of the samples tested for suspected <span class="elsevierStyleItalic">C. trachomatis</span> or <span class="elsevierStyleItalic">N. gonorrhoeae</span> disease were positive. The prevalence of hidden HIV infection in these patients was 1.72%. However, only 44.66% of patients were tested for HIV serology, with 55.33% of cases being MOD.</p><p id="par0060" class="elsevierStylePara elsevierViewall">The high rate of hidden HIV infection in patients with suspected STI is well known. Studies show the prevalence to be between 0.8% and 3%.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The high rate of association has several possible explanations. One of the most common symptoms shared by <span class="elsevierStyleItalic">C. trachomatis</span> and <span class="elsevierStyleItalic">N. gonorrhoeae</span> infection and other STI (syphilis, human papillomavirus infection, <span class="elsevierStyleItalic">Trichomonas</span> or herpes) is the development of ulcers or skin lesions which can cause inflammation of the affected area, whether rectal, vaginal or oral.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> This mechanism has an influence in two ways. On the one hand, it increases the risk of HIV infection in people who are not infected with HIV, but who have mucosal inflammation, due to the increase in lymphocytes (including CD4) in the affected area.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> While, on the other, people living with HIV who also have an STI are at increased risk of transmitting HIV through the sexual route, as increased lymphocytes in the genital tract are also associated with increased viral shedding by these routes.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> In fact, some studies estimate that 10% of new diagnoses of HIV infection among men who have sex with men are caused by an existing gonorrhoea or <span class="elsevierStyleItalic">Chlamydia</span> infection.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> In studies in epidemiological areas close to ours, 27.5% of their new HIV diagnoses had an STI at the time of diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In our study, in line with other observational studies, the number of MOD is high. Gargallo-Bernad et al.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> found that 16% of the new HIV diagnoses studied had previously consulted for an STI and these were on the list of indicator conditions which generated the most MOD in the late diagnosis population; 44% of their late diagnoses had previously consulted for an STI.</p><p id="par0070" class="elsevierStylePara elsevierViewall">This study has a series of limitations. Due to a lack of availability of data, we did not analyse the risk factors associated with a greater suspicion of hidden HIV infection by the clinician which led them to order testing or not. As this is a single-centre study, the results cannot be directly extrapolated to other centres or regions. Moreover, all the samples taken were exploited with a high statistical power, thanks to the exhaustiveness of the recording carried out.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The high prevalence of hidden HIV infection in people with these conditions, and the high degree of suspicion, will enable us to set a target for reinforcing early diagnosis strategies which will help us reduce the number of people with hidden infection. In our opinion, measures are needed to increase the level of suspicion of hidden HIV infection in people with these conditions. These measures should start with teaching and training in early detection of HIV infection, through missed opportunity markers and alert criteria, training courses, awareness campaigns and interdisciplinary clinical sessions.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Funding</span><p id="par0080" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleGrantSponsor" id="gs0005">Gilead Sciences</span>, S.L.U. contributed to the funding of this publication. This company had no involvement in the contents of this publication or the selection of authors.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Conflicts of interest</span><p id="par0085" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:11 [ 0 => array:3 [ "identificador" => "xres2099832" "titulo" => "Abstract" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] 1 => array:2 [ "identificador" => "xpalclavsec1789139" "titulo" => "Keywords" ] 2 => array:3 [ "identificador" => "xres2099833" "titulo" => "Resumen" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] 3 => array:2 [ "identificador" => "xpalclavsec1789138" "titulo" => "Palabras clave" ] 4 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 5 => array:2 [ "identificador" => "sec0010" "titulo" => "Material and methods" ] 6 => array:2 [ "identificador" => "sec0015" "titulo" => "Results" ] 7 => array:2 [ "identificador" => "sec0020" "titulo" => "Discussion" ] 8 => array:2 [ "identificador" => "sec0025" "titulo" => "Funding" ] 9 => array:2 [ "identificador" => "sec0030" "titulo" => "Conflicts of interest" ] 10 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2023-05-31" "fechaAceptado" => "2023-08-15" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Keywords" "identificador" => "xpalclavsec1789139" "palabras" => array:4 [ 0 => "HIV" 1 => "Early diagnosis" 2 => "Chlamydia" 3 => "Gonorrhea" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec1789138" "palabras" => array:4 [ 0 => "VIH" 1 => "Diagnóstico precoz" 2 => "Chlamydia" 3 => "Gonorrea" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:3 [ "titulo" => "Abstract" "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Introduction</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Sexually transmitted diseases such as cervicitis, proctitis and urethritis are associated with high rates of HIV infection. When these pathologies are suspected, HIV serology should be requested.</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A retrospective study was performed during 2018 at the Hospital Costa del Sol (Marbella, Málaga, Spain). HIV serologies requested in patients who were asked for PCR for <span class="elsevierStyleItalic">Chlamydia trachomatis</span> and <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span> were reviewed.</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">A total of 1818 patients were evaluated, in which HIV serology was performed in 44.7%, of which 14 (1.7%) were positive. The remaining 55.3% were missed diagnostic opportunities.</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">C. trachomatis</span> and <span class="elsevierStyleItalic">N. gonorrhoeae</span> infections are associated with a high rate of occult HIV infection. The degree of suspicion of HIV in this population remains low and it is essential that it be reinforced in the presence of the possibility of infection by these pathologies.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "abst0010" "titulo" => "Material and methods" ] 2 => array:2 [ "identificador" => "abst0015" "titulo" => "Results" ] 3 => array:2 [ "identificador" => "abst0020" "titulo" => "Conclusions" ] ] ] "es" => array:3 [ "titulo" => "Resumen" "resumen" => "<span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Introducción</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Las enfermedades de transmisión sexual, como la cervicitis, la proctitis y la uretritis, se asocian a altas tasas de infección por VIH. Ante la sospecha de estas patologías, se debería solicitar una serología del VIH.</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Material y métodos</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Estudio retrospectivo realizado durante 2018 en el Hospital Costa del Sol (Marbella, Málaga). Se revisaron las serologías para el VIH solicitadas en pacientes a los que se les pidió una PCR para <span class="elsevierStyleItalic">Chlamydia trachomatis</span> y <span class="elsevierStyleItalic">Neisseria gonorrhoeae</span>.</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Resultados</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Se valoraron 1.818 pacientes, en los que se realizó serología para el VIH al 44,7%, de las cuales 14 (1,7%) resultaron positivas. El 55,3% restante fueron oportunidades perdidas de diagnóstico.</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Conclusiones</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Las infecciones por <span class="elsevierStyleItalic">C. trachomatis</span> y <span class="elsevierStyleItalic">N. gonorrhoeae</span> están asociadas a una elevada tasa de infección oculta por el VIH. El grado de sospecha de VIH en esta población sigue siendo bajo, y resulta esencial que se refuerce ante la posibilidad de infección por estas patologías.</p></span>" "secciones" => array:4 [ 0 => array:2 [ "identificador" => "abst0025" "titulo" => "Introducción" ] 1 => array:2 [ "identificador" => "abst0030" "titulo" => "Material y métodos" ] 2 => array:2 [ "identificador" => "abst0035" "titulo" => "Resultados" ] 3 => array:2 [ "identificador" => "abst0040" "titulo" => "Conclusiones" ] ] ] ] "multimedia" => array:1 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1323 "Ancho" => 1508 "Tamanyo" => 120940 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Flow chart of study patients.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:15 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Advanced HIV disease: a review of diagnostic and prophylactic strategies" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Lehman" 1 => "J. Ellis" 2 => "E. Nalintya" 3 => "N.C. Bahr" 4 => "A. Loyse" 5 => "R. Rajasingham" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/hiv.13487" "Revista" => array:6 [ "tituloSerie" => "HIV Med" "fecha" => "2023" "volumen" => "24" "paginaInicial" => "859" "paginaFinal" => "876" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/37041113" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Late presentation of HIV infection: a consensus definition" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A. Antinori" 1 => "T. Coenen" 2 => "D. Costagiola" 3 => "N. Dedes" 4 => "M. Ellefson" 5 => "J. Gatell" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1468-1293.2010.00857.x" "Revista" => array:6 [ "tituloSerie" => "HIV Med" "fecha" => "2011" "volumen" => "12" "paginaInicial" => "61" "paginaFinal" => "64" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20561080" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The late diagnosis and consequent short-term mortality of HIV-infected heterosexuals (England and Wales, 2000-2004)" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "T.R. Chadborn" 1 => "V.C. Delpech" 2 => "C.A. Sabin" 3 => "K. Sinka" 4 => "B.G. Evans" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/QAD.0b013e32801138f7" "Revista" => array:6 [ "tituloSerie" => "AIDS" "fecha" => "2006" "volumen" => "20" "paginaInicial" => "2371" "paginaFinal" => "2379" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17117024" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0020" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Missed opportunities in the diagnosis of human immunodeficiency virus infection in the Region of Aragon. Late diagnosis importance" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "C. Gargallo-Bernad" 1 => "F.J. Sangrós-González" 2 => "P. Arazo-Garcés" 3 => "R. Martínez-Álvarez" 4 => "C. Malo-Aznar" 5 => "A. Gargallo-Bernad" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.eimc.2018.03.007" "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin (Engl Ed)" "fecha" => "2019" "volumen" => "37" "paginaInicial" => "100" "paginaFinal" => "108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29724618" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Unidad de vigilancia del VIH, ITS y hepatitis B y C. Actualización del Continuo de Atención del VIH en España, 2021. Madrid: Centro Nacional de Epidemiología – Instituto de Salud Carlos III/División de control de VIH, ITS, Hepatitis Virales y Tuberculosis – Dirección General de Salud Pública; 2023." ] ] ] 5 => array:3 [ "identificador" => "bib0030" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:1 [ "referenciaCompleta" => "Madrid: Centro Nacional de Epidemiología – Instituto de Salud Carlos III/Plan Nacional sobre el Sida – Dirección General de Salud Pública. Unidad de Vigilancia de VIH, ITS y hepatitis. Vigilancia Epidemiológica del VIH y sida en España 2019: Sistema de Información sobre Nuevos Diagnósticos de VIH y Registro Nacional de Casos de Sida; 2020." ] ] ] 6 => array:3 [ "identificador" => "bib0035" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Improving the evidence for indicator condition guided HIV testing in Europe: results from the HIDES II study — 2012-2015" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "D. Raben" 1 => "A.K. Sullivan" 2 => "A. Mocroft" 3 => "G. Kutsyna" 4 => "V. Hadžiosmanović" 5 => "A. Vassilenko" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0220108" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2019" "volumen" => "14" "paginaInicial" => "e0220108" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31408476" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0040" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Guía de recomendaciones para el diagnóstico precoz del VIH en el ámbito sanitario" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "Ministerio de Sanidad" 1 => "Servicios Soiales e Igualdad" ] ] ] ] ] "host" => array:2 [ 0 => array:1 [ "Libro" => array:2 [ "fecha" => "2014" "editorial" => "Dirección General de Salud Pública" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.sanidad.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/docs/GuiaRecomendacionesDiagnosticoPrecozVIH.pdf" ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0045" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:1 [ "titulo" => "Documento de Consenso de la Secretaría del Plan Nacional sobre el Sida/SEMES/GESIDA sobre urgencias y virus de la inmunodeficiencia humana" ] ] "host" => array:2 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Enferm Infecc Microbiol Clin" "fecha" => "2013" "volumen" => "31" "numero" => "7" "paginaInicial" => "455.e1" "paginaFinal" => "455.e16" ] ] 1 => array:1 [ "WWW" => array:1 [ "link" => "https://www.elsevier.es/es-revista-enfermedades-infecciosas-microbiologia-clinica-28-articulo-documento-consenso-secretaria-del-plan-S0213005X13000529" ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0050" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "A.K. Sullivan" 1 => "D. Raben" 2 => "J. Reekie" 3 => "M. Rayment" 4 => "A. Mocroft" 5 => "S. Esser" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1371/journal.pone.0052845" "Revista" => array:5 [ "tituloSerie" => "PLoS One" "fecha" => "2013" "volumen" => "8" "paginaInicial" => "e52845" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23341910" "web" => "Medline" ] ] ] ] ] ] ] ] 10 => array:3 [ "identificador" => "bib0055" "etiqueta" => "11" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sexually transmitted infections treatment guidelines, 2021" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "K.A. Workowski" 1 => "L.H. Bachmann" 2 => "P.A. Chan" 3 => "C.M. Johnston" 4 => "C.A. Muzny" 5 => "I. Park" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.15585/mmwr.rr7004a1" "Revista" => array:6 [ "tituloSerie" => "MMWR Recomm Rep" "fecha" => "2021" "volumen" => "70" "paginaInicial" => "1" "paginaFinal" => "187" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/34978547" "web" => "Medline" ] ] ] ] ] ] ] ] 11 => array:3 [ "identificador" => "bib0060" "etiqueta" => "12" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Contribution of sexually transmitted infections to the sexual transmission of HIV" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "H. Ward" 1 => "M. Rönn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/COH.0b013e32833a8844" "Revista" => array:6 [ "tituloSerie" => "Curr Opin HIV AIDS" "fecha" => "2010" "volumen" => "5" "paginaInicial" => "305" "paginaFinal" => "310" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20543605" "web" => "Medline" ] ] ] ] ] ] ] ] 12 => array:3 [ "identificador" => "bib0065" "etiqueta" => "13" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The effect of genital tract infections on HIV-1 shedding in the genital tract: a systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "L.F. Johnson" 1 => "D.A. Lewis" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0b013e3181812d15" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2008" "volumen" => "35" "paginaInicial" => "946" "paginaFinal" => "959" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18685546" "web" => "Medline" ] ] ] ] ] ] ] ] 13 => array:3 [ "identificador" => "bib0070" "etiqueta" => "14" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Proportion of incident human immunodeficiency virus cases among men who have sex with men attributable to Gonorrhea and Chlamydia: a modeling analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Jones" 1 => "K. Weiss" 2 => "J. Mermin" 3 => "P. Dietz" 4 => "E.S. Rosenberg" 5 => "T.L. Gift" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/OLQ.0000000000000980" "Revista" => array:6 [ "tituloSerie" => "Sex Transm Dis" "fecha" => "2019" "volumen" => "46" "paginaInicial" => "357" "paginaFinal" => "363" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/31095100" "web" => "Medline" ] ] ] ] ] ] ] ] 14 => array:3 [ "identificador" => "bib0075" "etiqueta" => "15" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Profile of new HIV diagnoses and risk factors associated with late diagnosis in a specialized outpatient clinic during the 2014-2018 period" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "Z.R. Palacios-Baena" 1 => "M. Martín-Ortega" 2 => "M.J. Ríos-Villegas" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.medcli.2020.01.035" "Revista" => array:6 [ "tituloSerie" => "Med Clin (Barc)" "fecha" => "2020" "volumen" => "155" "paginaInicial" => "482" "paginaFinal" => "487" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/32418627" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/2529993X/0000004200000003/v1_202403030914/S2529993X24000108/v1_202403030914/en/main.assets" "Apartado" => array:4 [ "identificador" => "66624" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Brief reports" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/2529993X/0000004200000003/v1_202403030914/S2529993X24000108/v1_202403030914/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2529993X24000108?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 11 | 2 | 13 |
| 2024 September | 48 | 3 | 51 |
| 2024 August | 5 | 2 | 7 |
| 2024 March | 3 | 0 | 3 |
