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"documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "Med Clin. 2021;156:297-300" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Clinical report</span>" "titulo" => "Uterine transplantation. First viable case in Southern Europe" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "297" "paginaFinal" => "300" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Trasplante uterino. Primer caso viable en el sur de Europa" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 2397 "Ancho" => 1667 "Tamanyo" => 285830 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">(A) Doppler assessment of left uterine artery with transabdominal ultrasound scan 1 week after the procedure, showing normal arterial flow. 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MRI: magnetic resonance; AP: anatomical pathology; Rt: radiotherapy.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Pérez-López, Cristina Álvarez-Escolá, Alberto Isla Guerrero" "autores" => array:3 [ 0 => array:2 [ "nombre" => "Carlos" "apellidos" => "Pérez-López" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "Álvarez-Escolá" ] 2 => array:2 [ "nombre" => "Alberto" "apellidos" => "Isla Guerrero" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S002577532030854X" "doi" => "10.1016/j.medcli.2020.08.019" "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/S002577532030854X?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621000747?idApp=UINPBA00004N" "url" => "/23870206/0000015600000006/v1_202103200954/S2387020621000747/v1_202103200954/en/main.assets" ] "en" => array:18 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Special article</span>" "titulo" => "Current epidemiological status of HIV-2 and HTLV-1 infection in Spain" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "290" "paginaFinal" => "296" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Carmen de Mendoza, José Manuel Ramos, Estrella Caballero, Vicente Soriano" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Carmen" "apellidos" => "de Mendoza" "email" => array:1 [ 0 => "cmendoza.cdm@gmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "*" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José Manuel" "apellidos" => "Ramos" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => "Estrella" "apellidos" => "Caballero" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] 3 => array:3 [ "nombre" => "Vicente" "apellidos" => "Soriano" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] ] ] 4 => array:2 [ "colaborador" => "on behalf of the Spanish HTLV and HIV-2 Study Group" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">◊</span>" "identificador" => "fn0005" ] ] ] ] "afiliaciones" => array:4 [ 0 => array:3 [ "entidad" => "Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda-Segovia de Arana Majadahonda, Madrid, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Hospital General Universitario de Alicante and Universidad Miguel Hernádez, Alicante, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Hospital Universitario Vall d’Hebrón, Barcelona, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Facultad de Ciencias de la Salud y Centro Médico, UNIR, Madrid, Spain" "etiqueta" => "d" "identificador" => "aff0020" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Situación epidemiológica actual de la infección por VIH-2 y HTLV-1 en España" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1278 "Ancho" => 2014 "Tamanyo" => 161051 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Incidence of HIV-2 in Spain. Data updated December 2019.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">The family Retroviridae includes 7 subfamilies. Two have members that infect humans and are pathogenic. These are delta-retroviruses, of which the <span class="elsevierStyleItalic">human T-cell lymphotropic virus</span> (HTLV) type 1 (HTLV-1) is the best known, and the lentiviruses, of which HIV type 1 (HIV-1) is the most important.</p><p id="par0010" class="elsevierStylePara elsevierViewall">HTLV-1 was the first retrovirus identified. It was isolated in 1980 from a cell line of a cutaneous T-lymphocyte lymphoma. It was an <span class="elsevierStyleItalic">adult T-cell leukemia/lymphoma</span> (ATLL). Two years later, a second retrovirus was identified as a close relative to HTLV-1, which was named HTLV-2. After AIDS was described, HIV-1 (originally named HTLV-III) was isolated in 1983. Finally, in 1986 HIV-2 was isolated from AIDS patients who had negative and/or indeterminate serology for HIV-1.</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">HTLV-1</span><p id="par0015" class="elsevierStylePara elsevierViewall">HTLV-1 infection is a neglected disease despite affecting around 15 million people worldwide.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> As in HIV infection, chronicity uniformly occurs following acute HTLV-1 infection with no self-limited episodes. However, less than 10% of HTLV-1 carriers develop clinical manifestations which include 2 severe diseases, one being a disabling subacute myelopathy known as <span class="elsevierStyleItalic">tropical spastic paraparesis</span> (TSP)<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> and the other being an ATLL.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Like other human retroviruses, HTLV-1 infects the CD4+ T lymphocytes. However, unlike HIV-1 and HIV-2 that cause cell lysis and immunodeficiency (AIDS in advanced stages), HTLV-1 causes dysfunction and/or immortalisation of infected cells. The proliferation of infected CD4+ T lymphocytes can progress to ATLL, whereas TSP represents a pathological immune response against the HTLV-1 antigens on spinal cord cells.</p><p id="par0020" class="elsevierStylePara elsevierViewall">In contrast to HIV-1 and HIV-2, which passed from primates to humans in the last century, HTLV-1 has infected humans for thousands of years, as evidenced by its presence in fossil mummies from Latin America.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> In acute HTLV-1 infection, the viral genome integrates within CD4+ T lymphocytes and expands primarily through viral synapses and cell proliferation,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> which explains the absence of plasma viremia in carriers. A strong cytotoxic T lymphocyte response by the host is triggered, establishing a stable proportion of infected T cells in each subject within a few weeks. This proviral load value has clinical prognostic value.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> The median HTLV-1 proviral load in TSP patients is 5 copies/100 peripheral blood mononuclear cells, while in asymptomatic carriers it is less than 1 copy/100 cells. It is noteworthy that the HTLV-1 proviral load is much higher than in the HIV-1 infection, in which the provirus is recognised as integrated in less than 1/1000 peripheral blood cells. Another important difference between the two retroviruses refers to genetic variability. In people infected with HTLV-1 it is minimal, since viral expansion occurs mainly in the form of cell proliferation and only occasionally requires reverse transcriptase. In contrast, the HIV-1 infection has high genetic intra- and inter-individual variability, with an evolutionary dynamic that follows the quasispecies model.</p><p id="par0025" class="elsevierStylePara elsevierViewall">HTLV-1 is transmitted perinatally (breastfeeding), sexually (male to female mainly), and parenterally (transfusions, injection drug use, and transplants).<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Diagnosis is based on the demonstration of specific anti-HTLV-1 antibodies in serum or plasma. An elevated HTLV-1 proviral load predicts the risk of developing symptoms<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> as well as sexual transmission.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> To date, there is no prophylactic vaccine or effective antiviral therapy.</p><p id="par0030" class="elsevierStylePara elsevierViewall">There are highly endemic regions for the HTLV-1 infection in southern Japan, Iran, Papua New Guinea, sub-Saharan Africa, parts of South America, and in the Caribbean.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> HTLV-1 infection is quite low in Europeans, with the exception of Romania.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> However, the rate of HTLV-1 infection in Europe has been increasing over the last decades, mainly among immigrants from endemic areas, travellers and those with whom they have had sexual contact.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">HIV-2</span><p id="par0035" class="elsevierStylePara elsevierViewall">This HIV variant was first described in 1986 in two West African patients with AIDS. The isolated virus was found to have different antigenicity and genome (40% different nucleotides) to that of HIV-1.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Both HIV-1 and HIV-2 belong to the lentivirus genus, within the family Retroviridae. Viral infection of CD4+ T lymphocytes causes cell dysfunction and ultimately loss, causing secondary immunodeficiency. However, HIV-2 carriers develop AIDS after an average of 20 years, a longer interval than the 10-year period described for untreated HIV-1 infection.</p><p id="par0040" class="elsevierStylePara elsevierViewall">In HIV-2 infection, the slower progression to AIDS and the lower risk of transmission, both sexually and from mother to child, are directly correlated with a lower plasma HIV-2 RNA load compared to HIV-1 infection.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The limited transmissibility of HIV-2 together with preventive efforts, including circumcision in sub-Saharan Africa, appear to lead to the extinction of the HIV-2 epidemic.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">HIV-1 and HIV-2 are the result of multiple cross-species transmissions between primates (<span class="elsevierStyleItalic">simian immunodeficiency virus,</span> SIV) to humans. The natural infection of SIV in monkeys does not cause any disease. Of the 18 different lentiviruses that infect primates, the origin of HIV-2 was SIV which infects the <span class="elsevierStyleItalic">sooty mangabeys</span> (SIVsmm).<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Sometime late in the <span class="elsevierStyleSmallCaps">xix</span> century, the SIVsmm was introduced into the human species as a result of a zoonotic transmission, probably related to hunting activities in the tropical forest of the Ivory Coast.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> An initial adaptive change of the virus was necessary<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> for it to be acquired by and spread efficiently within the human population. From West Africa it expanded to the rest of the planet in successive decades.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">At least eight independent transmissions of SIVsmm to humans have occurred in West Africa.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a> The viral isolates have been named as HIV-2 groups A to H. Group A is the most frequent, followed by group B. Due to their sporadic nature, groups C to H are assumed to represent isolated “dead-end” transmissions. SIVsmm continues to be transmitted to humans and may cause new zoonotic outbreaks. In contrast, HIV-1 was the result of at least four cross-species transmissions of SIV from chimpanzees and gorillas in Central and West Africa (Cameroon), where one of these transmissions (HIV-1 group M) has been largely responsible for the global AIDS epidemic.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Currently, an estimated 1–2 million people are infected with HIV-2, including those with dual HIV-1/HIV-2 infections. In contrast to the global spread of HIV-1, HIV-2 has been mainly restricted to some West African countries, where it is endemic.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> Migratory flows from the epicenter in Guinea-Bissau were favoured by Portugal's war of independence between 1963 and 1974, spreading HIV-2 to Portugal and its former colonies.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> This explains the recognition of HIV-2 in areas of Brazil, India, Angola and Mozambique. Further expansion to other countries, including USA,<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a> has been directly produced by immigrants from West Africa. In Europe, the HIV-2 infection has been found in countries other than Portugal that also have strong colonial and socioeconomic ties to West Africa, such as France and Belgium.</p><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Spanish HTLV/HIV-2 Study Group</span><p id="par0060" class="elsevierStylePara elsevierViewall">It was founded in 1989 after the identification of the first cases of infection of both viruses in Spain. Currently, more than 60 hospitals and microbiological diagnostic centres, located throughout Spain (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) form a part of the Study Group, which includes microbiologists, infectologists, hematologists, neurologists and specialists in internal Medicine.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Annually, in December, the group holds a meeting in which the data on HTLV and HIV-2 infection in Spain are updated. During this meeting, new cases, and the resulting diagnostic and clinical experience is discussed. The group objectives include understanding the epidemiology of HTLV and HIV-2 infection in Spain, analysing the characteristics of patients with HTLV infection, and evaluating the patients’ response to antiretroviral treatment and the resistance pattern characteristics of HIV-2 infection. In addition, the group works on and writes up clinical and diagnostic recommendations based on their experience.<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20,21</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">When faced with a new diagnosis of HTLV or HIV-2 infection, the hospital doctor or microbiologist fills out a case record sheet, which is sent to the coordinating centre. The details filled in on this sheet include: (1) Demographic data: age, sex, country of origin and race. (2) Epidemiological data: possible route of infection, stays or visits to other countries, time of residence in Spain, relationships with people from endemic areas, etc. (3) Clinical data: HTLV infection: symptoms associated with HTLV-1 and treatment received; HIV-2 infection: number of CD4+ T lymphocytes, HIV-1 coinfection, symptoms associated with HIV infection, antiretroviral treatment. The proposed epidemiological studies have the approval of the clinical research ethics committees of the corresponding centres.</p><p id="par0075" class="elsevierStylePara elsevierViewall">The case register includes a collection of samples that help with the analysis of the HTLV proviral load and the virus subtype in the case of HTLV infection, and the study of the HIV-2 viral load, the study of resistance to antiretrovirals when necessary and the genetic subtype of the virus in cases of HIV-2 infection.</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">HTLV-1 infection in Spain</span><p id="par0080" class="elsevierStylePara elsevierViewall">As of December 2019, a total of 389 cases of HTLV-1 infection have been diagnosed. In general, 65% are immigrants from Latin America and 11% from Africa, with only 17% being native Spanish. HTLV-1 diagnoses are mostly in women (62%) and the median age at diagnosis is 41 years. <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> summarises the main characteristics of the HTLV-1 population reported to date in the Spanish register.</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">HTLV-1 cases in Spain are concentrated in the largest urban areas (Madrid and Barcelona) where the largest immigrant populations live. However, people infected with HTLV-1 have been identified throughout Spain. Almost 47 million people currently live in Spain, of which around 6 million are foreigners. In addition, 75 million visitors/tourists came to Spain during 2018, more than 10% from HTLV-1 endemic regions.</p><p id="par0090" class="elsevierStylePara elsevierViewall">Symptomatic HTLV-1 infections have been diagnosed in 79 (20.3%) of the viral carriers living in Spain, with 45 cases of TSP and 27 patients with ATLL. New diagnoses of HTLV-1 infection have increased considerably in Spain since 2008 (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), largely as a result of the introduction of HTLV screening in blood banks and the increasing arrival of immigrants and tourists from endemic regions. However, the current incidence of new HTLV-1 diagnoses in Spain remains stable, around 20–25 cases per year.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">In 2019, a total of 20 new cases of HTLV-1 were diagnosed in Spain. Only one was Spanish, 16 Latin American, 2 African, and one from Iran. Six (30%) had symptomatic disease, and this was divided into three with TSP, two with neurological symptoms, and one with infection by <span class="elsevierStyleItalic">Strongyloides stercoralis</span>.</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">HTLV in blood banks and solid organ transplantation</span><p id="par0100" class="elsevierStylePara elsevierViewall">During the last decade, blood banks have contributed to more than half of the new HTLV-1 diagnoses in Spain annually (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>). In fact, 9 out of 20 new cases reported during 2019 were identified in people who came to the blood bank to be blood donors. It should be noted that of the cases diagnosed in 2018, 3 were seroconversions in habitual blood donors (in previous donations they were HTLV negative). Even so, the current estimated seroprevalence of HTLV-1 is less than 1/100,000 donations in Spain, similar to that reported in other western countries.</p><p id="par0105" class="elsevierStylePara elsevierViewall">Spain is the world's leading country in solid organ transplants. The annual figure is constantly increasing, and is currently at more than 5000 transplants per year. To date, more than 100,000 people have benefitted from organ donations. More than 60% are kidney transplants, with liver being the second most common allograft. Heart, lung, and pancreas are transplanted less often.</p><p id="par0110" class="elsevierStylePara elsevierViewall">In Spain, the first cases of HTLV transmission were identified in the context of organ transplantation in 2000. Two kidney recipients and one liver recipient acquired HTLV-1 infection as a consequence of transplantation from the same donor who was a young Spanish male. All 3 patients developed <span class="elsevierStyleItalic">HTLV-1 associated myelopathy</span>/<span class="elsevierStyleItalic">tropical spastic paraparesis</span> (HAM/TSP) 18 months after transplant surgery. During 2016, a kidney transplant recipient in Spain developed TSP within the first year of surgery. Interestingly, a second kidney transplant recipient from the same infected donor, a native Spaniard, was also infected with HTLV-1, but has not developed any disease to date.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a> However, this second allograft was removed after rejection 6 months after transplantation and, since then, the patient is no longer on immunosuppressants. In Spain, current legislation only recommends screening for HTLV in those individuals from an endemic area, or who are children of people from an endemic area or who have had sexual relations with people from these areas. However, in many cases it is difficult to accurately identify the risk factors, as precise knowledge about these aspects is needed prior to donation. In fact, the cases in Spain have been from Spanish donors with no initial suspicion of the transmission risk. This circumstance, together with the poor prognosis of patients who acquire HLTV in the context of transplantation, highlights the need to include universal screening in all organ transplants.<a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22–24</span></a></p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Estimation of HTLV-1 infection in Spain</span><p id="par0115" class="elsevierStylePara elsevierViewall">Almost 250 million of the 7.5 billion people around the world are migrants and currently live in countries where they were not born. The most important global migratory flows are in Asia, Europe and Africa, and from Latin America to North America. The largest intercontinental migration flows are from Asia to North America and Europe, and from Africa to Europe.</p><p id="par0120" class="elsevierStylePara elsevierViewall">The most frequent migratory flows in Europe are from highly endemic regions of HTLV-1, as follows: Latin America-Caribbean<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>Africa<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>Japan<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>Iran<span class="elsevierStyleHsp" style=""></span>><span class="elsevierStyleHsp" style=""></span>Romania. In Spain, in 2017, there were 5,852,953 foreign residents, which represents 12.7% of the total population. In total, 2,293,711 people were originally from countries where HTLV-1 is endemic (1,567,034 Latin Americans; 56,529 Africans; 658,132 Romanians; 6128 Japanese; 5888 Iranians). Taking into account the estimate of HTLV-1 infection in the country of origin,<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> between 16,050 and 48,920 people could be infected with HTLV-1 in Spain. These values do not take into account horizontal transmission in the native Spanish population, so the number of cases could be higher.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a></p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Clinical relevance of HTLV-1 infection</span><p id="par0125" class="elsevierStylePara elsevierViewall">As already mentioned, the 2 most frequent clinical entities in patients with HTLV-1 infection are TSP and ATLL. However, there is a wide range of diseases (Sjögren's syndrome, pediatric eczema, bronchiectasis, asthma, fibromyalgia, arthritis, tuberculosis, etc.) that, although not fatal, appear to be frequent in individuals with HTLV-1 infection. Furthermore, in a recently published meta-analysis,<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a> an increased risk of premature death has been observed in patients with HTLV-1 infection that is not explained by the presence of these diseases. The authors indicate that the impact of this infection is not well known, and the relationship of HTLV-1 with cardiovascular disease, cerebrovascular disease and metabolic syndrome could be relevant.</p><p id="par0130" class="elsevierStylePara elsevierViewall">On a national level, the Spanish group has analysed the clinical impact of HTLV-1 on hospital admissions in the last 20 years.<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> Information was obtained from more than 66 million admissions, of which only 135 included the diagnosis of HTLV. This shows that the rate of diagnosis of HTLV infection in hospitalised patients in Spain has been low (2 cases per million admissions) and stable over the last 20 years, despite the high flow of immigration from HTLV-1 endemic areas. The underdiagnosis of this infection in Spain could partially justify this observation. Up to two-thirds of the most frequent clinical complications of patients with HTLV-1 infection that lead to hospital admission in our country, are myelopathy (TSP) and leukemia (ATLL). However, other highly prevalent diseases such as cardiovascular events, neurodegenerative diseases, osteoporosis, metabolic syndrome, etc., are present in almost 25% of hospitalised HTLV-1 patients.<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">HIV-2 infection in Spain</span><p id="par0135" class="elsevierStylePara elsevierViewall">As of December 2019, a total of 393 cases of HIV-2 infection have been diagnosed in Spain. The mean age of the identified patients is 42 years (from one to 83 years). 63% are males, mostly from sub-Saharan African countries (76%). However, 14% of the identified patients are native Spanish (55 cases). Unlike that observed in HIV-1 infection in our country, most patients with HIV-2 infection have acquired the infection through heterosexual contacts (64.6%) and only 3.8% through homosexual relationships. 10% of the cases also present HIV-1 infection (<a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>).</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0140" class="elsevierStylePara elsevierViewall">HIV-2 infection cases have been identified in all the autonomous regions, ranging from one case in the Principality of Asturias, La Rioja and Murcia to 117 cases in Catalonia. The incidence of cases has steadily increased, with 62% of cases identified since 2007. This means that an average of 19 cases/year have been identified since 2007, compared to 7 cases/year in the period between 1989 and 2006 (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>).</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0145" class="elsevierStylePara elsevierViewall">In terms of the molecular epidemiology of HIV-2, the majority of patients are subtype A, the predominant subtype worldwide. However, 18 cases are carriers of HIV-2 subtype B infection. The countries of origin of these cases are: 5 from Equatorial Guinea, 6 from Spain, 4 from Senegal, 2 from Ivory Coast, 1 from Burkina Faso).</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">HIV-1 and HIV-2 coinfection</span><p id="par0150" class="elsevierStylePara elsevierViewall">A total of 38 (10%) patients with HIV-2 infection also have HIV-1 infection. The RNA of both viruses was detected in plasma at least once in just 10 subjects (31.2%) during their follow-up.</p><p id="par0155" class="elsevierStylePara elsevierViewall">Men represent 67.6% of people with double infection. Their median age is 39 years, significantly younger than HIV-2 monoinfected people (43 years; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span>=<span class="elsevierStyleHsp" style=""></span>0.035). Most of the coinfected patients come from West African countries (70.6%), although 6 (17.6%) are native Spanish. The remaining 8 people came from other African countries (6), France (1) and Brazil (1). At the time of diagnosis, 9 (26.5%) presented events related to AIDS.</p><p id="par0160" class="elsevierStylePara elsevierViewall">Prior to starting antiretroviral therapy, the median CD4 count in patients with dual infection was 204 (97–427)<span class="elsevierStyleHsp" style=""></span>cells/μL, significantly lower than for individuals monoinfected with HIV-2 (445 [223–668]<span class="elsevierStyleHsp" style=""></span>cells/L; <span class="elsevierStyleItalic">p</span><span class="elsevierStyleHsp" style=""></span><<span class="elsevierStyleHsp" style=""></span>0.001). At the start of the study, plasma viremia was undetectable in 5% for HIV-1 and 45% for HIV-2. The mean plasma HIV RNA in virologically unsuppressed individuals was 4.9 and 3.7<span class="elsevierStyleHsp" style=""></span>log/ml copies, respectively. In HIV-1/HIV-2 coinfection, the choice of antiretroviral treatment is particularly relevant, as the regimen chosen must be active against both viruses.<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Response to antiretroviral treatment and development in HIV-2 infection</span><p id="par0165" class="elsevierStylePara elsevierViewall">The administration of an optimal antiretroviral regimen, as demonstrated in HIV-1 infected patients, effectively suppresses HIV-2 viral replication, with the resulting benefit of immunological and clinical improvement in patients.</p><p id="par0170" class="elsevierStylePara elsevierViewall">Highly active antiretroviral therapy consists of the administration of 3 different drugs that inhibit several key processes in viral replication. Thus, there are 5 currently approved families: entry inhibitors, non-nucleoside reverse-transcriptase inhibitors, nucleoside/nucleotide reverse transcriptase inhibitors, integrase inhibitors, and protease inhibitors. HIV-2 exhibits natural resistance to non-nucleoside reverse transcriptase inhibitors and a lower activity to certain integrase inhibitors, with the most active being boosted saquinavir, lopinavir and darunavir. Thus, an HIV-2 infected patient will have fewer options of effective drugs and this could lead to a suboptimal treatment administration in the future.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">18,21</span></a></p><p id="par0175" class="elsevierStylePara elsevierViewall">Over the years, the response to antiretroviral therapy in patients with HIV-2 infection has been evaluated, with recent interest focused on the response to combinations that include integrase inhibitors. As of December 2017, 44 patients had received treatment combinations that included integrase inhibitors, 18 of them as first line treatment and 26 having previously failed with other antiretroviral combinations. Eighty-nine percent of <span class="elsevierStyleItalic">naive</span> patients achieved undetectable viral load after starting treatment, whereas this was only achieved in 62% of patients receiving integrase inhibitors as second or third line treatment. The development of resistance mutations after virological failure was observed in 15 patients. In total, 5 patients developed changes at position 155H, 3 patients at position 148H/R, 3 at position 143C/G, and 1 at position 263K. In all cases, the primary mutations were accompanied by secondary mutations that increased the degree of resistance. The 3 patients who did not develop changes in the integrase gene presented changes in other regions such as the protease or reverse transcriptase, and these changes compromised the response to the accompanying drugs.<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29–31</span></a></p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Conclusions</span><p id="par0180" class="elsevierStylePara elsevierViewall">HTLV-1 infection is a neglected disease despite infecting 15 million people worldwide. Although Spain is not an endemic region, 389 HTLV-1 carriers have been reported to date, of which 72 have suffered a life-threatening disease. Persons who come from HTLV-1 endemic regions, mainly in Latin America, their sexual contacts or their children are over-represented in the Spanish HTLV-1 register. Since HTLV-1 infected mothers can prevent transmission to their babies by avoiding breastfeeding, and severe HTLV-1 diseases may develop more frequently and rapidly in transplant recipients, universal HTLV screening of these two populations should be mandatory in Spain, as well as in other non-endemic countries with a similar influx of immigrants from endemic regions.</p><p id="par0185" class="elsevierStylePara elsevierViewall">HIV-2 is also a <span class="elsevierStyleItalic">“neglected”</span> virus, despite causing AIDS and with estimates of 1–2 million carriers worldwide. In Spain, a non-endemic country, a total of 393 cases have been recorded to date. However, serological surveys indicate that approximately 5000 people infected with HIV-2 currently live in Spain.</p><p id="par0190" class="elsevierStylePara elsevierViewall">Underdiagnosis is frequent due to the lack of clinical suspicion by doctors, and the difficulties of many of those infected with HIV-2 to access the health system, given their illegal status as immigrants from endemic regions, mainly in West Africa.</p><p id="par0195" class="elsevierStylePara elsevierViewall">The unique characteristics of antiretroviral therapy and problems controlling the response to HIV-2 are major challenges. HIV-2, either alone or as a coinfection with HIV-1, should be excluded in all people with atypical HIV serological profiles, immunovirological disconnection (loss of CD4 count despite undetectable viremia) and/or strong epidemiological links (birth or sexual partners from endemic regions). Antiretroviral regimens, including integrase inhibitors, should be the preferred option when initiating antiretroviral therapy in these patients.</p></span><span id="sec0065" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Funding</span><p id="par0200" class="elsevierStylePara elsevierViewall">This work has been partially funded by the <span class="elsevierStyleGrantSponsor" id="gs0005">Fundación de Investigación y Educación en SIDA (F-IES) (AIDS Research and Education Foundation)</span> and with <span class="elsevierStyleGrantSponsor" id="gs0010">Health Research Funds</span> (FIS-ISCIII Feder Funds. Projects; <span class="elsevierStyleGrantNumber" refid="gs0010">CES12/003</span>, <span class="elsevierStyleGrantNumber" refid="gs0010">PI13/01574</span>; <span class="elsevierStyleGrantNumber" refid="gs0010">FI14/0264</span>; <span class="elsevierStyleGrantNumber" refid="gs0010">CD14/0243</span>).</p></span><span id="sec0070" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Conflict of interests</span><p id="par0205" class="elsevierStylePara elsevierViewall">The authors declare no conflict of interest.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:7 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Introduction" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "HTLV-1" ] 2 => array:3 [ "identificador" => "sec0015" "titulo" => "HIV-2" "secciones" => array:8 [ 0 => array:2 [ "identificador" => "sec0020" "titulo" => "Spanish HTLV/HIV-2 Study Group" ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "HTLV-1 infection in Spain" ] 2 => array:2 [ "identificador" => "sec0030" "titulo" => "HTLV in blood banks and solid organ transplantation" ] 3 => array:2 [ "identificador" => "sec0035" "titulo" => "Estimation of HTLV-1 infection in Spain" ] 4 => array:2 [ "identificador" => "sec0040" "titulo" => "Clinical relevance of HTLV-1 infection" ] 5 => array:2 [ "identificador" => "sec0045" "titulo" => "HIV-2 infection in Spain" ] 6 => array:2 [ "identificador" => "sec0050" "titulo" => "HIV-1 and HIV-2 coinfection" ] 7 => array:2 [ "identificador" => "sec0055" "titulo" => "Response to antiretroviral treatment and development in HIV-2 infection" ] ] ] 3 => array:2 [ "identificador" => "sec0060" "titulo" => "Conclusions" ] 4 => array:2 [ "identificador" => "sec0065" "titulo" => "Funding" ] 5 => array:2 [ "identificador" => "sec0070" "titulo" => "Conflict of interests" ] 6 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2020-02-25" "fechaAceptado" => "2020-05-13" "NotaPie" => array:2 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Please cite this article as: de Mendoza C, Ramos JM, Caballero E, Soriano V, en nombre del Grupo Español de Estudio del HTLV y VIH-2. Situación epidemiológica actual de la infección por VIH-2 y HTLV-1 en España. Med Clin (Barc). 2021;156:290–296.</p>" ] 1 => array:3 [ "etiqueta" => "◊" "nota" => "<p class="elsevierStyleNotepara" id="npar0015">See group components in Annex 1.</p>" "identificador" => "fn0005" ] ] "apendice" => array:1 [ 0 => array:1 [ "seccion" => array:2 [ 0 => array:3 [ "apendice" => "<p id="par0210" class="elsevierStylePara elsevierViewall">C. Rodríguez, M. Vera, O. Ayerdi and J. del Romero (Sandoval Health Centre, Madrid); G. Marcaida and M.D. Ocete (General University Hospital, Valencia); E. Caballero (Vall d’Hebrón Hospital, Barcelona); A. Aguilera, J.J. Rodríguez-Calviño, D. Navarro, C. Rivero and M.D. Vilariño (Conxo-CHUS Hospital, Santiago); R. Benito and J. Sahagún (Lozano Blesa University Clinic Hospital, Zaragoza); R. Ortiz de Lejarazu and S. Rojo (University Clinic Hospital, Valladolid); J.M. Eirós, M. Domíngez-Gil (Rio Hortega Hospital, Valladolid); C. Manzardo and J.M. Miró (Clinic Hospital-IDIBAPS, Barcelona); J. García (Cristal-Piñor Hospital, Orense); E. Calderón (Virgen del Rocío Hospital and CIBERESP, Seville); D. Escudero (Germans Trias i Pujol Hospital, Barcelona); M. Trigo, J. Diz and M. García-Campello (Hospital Complex, Pontevedra); M. Rodríguez-Iglesias (University Hospital, Puerto Real); A. Hernández-Betancor and A.M. Martín (Isle Hospital University Hospital, Las Palmas de Gran Canaria); J.M. Ramos and A. Gimeno (University Hospital, Alicante); C. Gómez-Hernando (Virgen de la Salud Hospital Complex, Toledo); G. Cilla and E. Pérez-Trallero (Donostia Hospital, San Sebastián); L. Fernández-Pereira (San Pedro de Alcántara Hospital, Cáceres); M. Hernández, A.M. López-Lirola and J.L. Gómez-Sirvent (La Laguna University Hospital, Tenerife); L. Force (General Hospital, Mataró); C. Cifuentes (Son Llátzer Hospital, Palma de Mallorca); S. Pérez and L. Morano (Meixoeiro Hospital, Vigo); C. Raya (Bierzo Hospital, Ponferrada); A. González-Praetorius (University Hospital, Guadalajara); M. Peñaranda (Son Espases Hospital, Mallorca); L. Roc (Miguel Servet Hospital, Zaragoza); I. Viciana (Virgen de la Victoria Hospital, Málaga); T. Cabezas (Torredecárdenas Hospital, Almeria); A. Lozano, E. Fernández-Fuertes and J.M. Fernández (Poniente Hospital, Almería); I. García-Bermejo and G. Gaspar (University Hospital, Getafe); M. Valeiro, L. Pérez and T. Aldamiz (Gregorio Marañón Hospital, Madrid); N. Margall (Santa Creu i Sant Pau Hospital, Barcelona); S. Sauleda and M. Pirón (Blood and Tissue Bank, Barcelona); R. González, A. Richart and L. Barea (Transfusion Centre, Madrid); A. Jiménez and L. Blanco (Castilla y León Hemotherapy and Hemodonation Centre, Valladolid); A. Suárez and I. Rodríguez-Avial (San Carlos Clinic Hospital, Madrid); P. Parra and M. Fernández (12 de Octubre University Hospital, Madrid); M. Fernández-Alonso and G. Reina (Navarra University Clinic, Pamplona); M.J. Echeverría (Donosti University Hospital); E. Ugalde, M.C. Nieto, P. Liendo (Basurto University Hospital); L. Benítez-Gutiérrez, A. Arias, V. Moreno-Torres, V. Cuervas-Mons and C. de Mendoza (IIS Puerta de Hierro University Hospital, Majadahonda); P. Barreiro (La Paz University Hospital, Madrid); V. Soriano, O. Corral and F. Gómez-Gallego (UNIR Health Sciences School, Madrid).</p>" "titulo" => "Annex 1. Members of the Spanish HTLV/HIV-2 Study Group" "identificador" => "sec0075" ] 1 => array:4 [ "apendice" => "<p id="par0220" class="elsevierStylePara elsevierViewall">The following are the supplementary data to this article:<elsevierMultimedia ident="upi0005"></elsevierMultimedia></p>" "etiqueta" => "Appendix" "titulo" => "Supplementary data" "identificador" => "sec0085" ] ] ] ] "multimedia" => array:6 [ 0 => array:8 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 2492 "Ancho" => 3333 "Tamanyo" => 624378 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0005" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Provinces with hospitals with HTLV-1 and HIV-2 diagnoses, belonging to the Spanish HTLV/HIV-2 Study Group.</p>" ] ] 1 => array:8 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1278 "Ancho" => 2014 "Tamanyo" => 175757 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0010" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Incidence of HTLV-1 in Spain. Data updated December 2019.</p>" ] ] 2 => array:8 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1278 "Ancho" => 2014 "Tamanyo" => 161051 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0015" "detalle" => "Fig. " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Incidence of HIV-2 in Spain. Data updated December 2019.</p>" ] ] 3 => array:8 [ "identificador" => "tbl0005" "etiqueta" => "Table 1" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0020" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "leyenda" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">ATLL: <span class="elsevierStyleItalic">adult T cell leukemia/lymphoma</span>; HAM/TSP: <span class="elsevierStyleItalic">HTLV-1 associated myelopathy</span>/<span class="elsevierStyleItalic">tropical spastic paraparesis</span>; PDU: parenteral drug users.</p>" "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">389 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Sex,</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Male/female</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">135 (34.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Female</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">241 (62) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unknown</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">13 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Mean age (range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">41 (3–78) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Origin:</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Spain</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">65 (16.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Latin America</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">254 (65.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Africa</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">43 (11) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Other European countries</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Iran</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">China</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Risk group:</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Sexual</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Heterosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">124 (31.9) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Homosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Parenteral</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Transfusion history \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">10 (2.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>PDU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">12 (3.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleHsp" style=""></span>Transplant \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">6 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Vertical</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">30 (7.7) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Unknown</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">197 (50.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">HIV-1 coinfection,</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">24 (6.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleBold">Clinical condition:</span><span class="elsevierStyleItalic"><span class="elsevierStyleBold">n</span></span><span class="elsevierStyleBold">(%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">79 (20.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">HAM/TSP</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">45 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">ATLL</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">27 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">Strongyloides stercoralis</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2552399.png" ] ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">General characteristics of patients with HTLV-1 infection in Spain (1989–2019).</p>" ] ] 4 => array:8 [ "identificador" => "tbl0010" "etiqueta" => "Table 2" "tipo" => "MULTIMEDIATABLA" "mostrarFloat" => true "mostrarDisplay" => false "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0025" "detalle" => "Table " "rol" => "short" ] ] "tabla" => array:2 [ "tablatextoimagen" => array:1 [ 0 => array:2 [ "tabla" => array:1 [ 0 => """ <table border="0" frame="\n \t\t\t\t\tvoid\n \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black"><span class="elsevierStyleItalic">N</span> \t\t\t\t\t\t\n \t\t\t\t\t\t</th><th class="td" title="\n \t\t\t\t\ttable-head\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t" scope="col" style="border-bottom: 2px solid black">393 \t\t\t\t\t\t\n \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Sex: n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Male \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">249 (63.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Female \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">139 (35.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">5 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Mean age (range)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">42 (0–83) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Origin: n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Spain \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">55 (14) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Africa \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">302 (76.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Asia \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">1 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>America \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Other European countries \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">11 (2.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">17 (4.3) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Risk group: n (%)</span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heterosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">254 (64.6) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Homosexual \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">15 (3.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>PDU \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">7 (1.8) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Vertical \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">2 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Others \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">3 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Unknown \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">111 (28.2) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " colspan="2" align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">AIDS: n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">63 (16.1) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">HIV-1 coinfection: n (%)</span> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">38 (10) \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleItalic">Subtype</span><a class="elsevierStyleCrossRef" href="#tblfn0005">*</a> \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"> \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>A \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">113 \t\t\t\t\t\t\n \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>B \t\t\t\t\t\t\n \t\t\t\t</td><td class="td" title="\n \t\t\t\t\ttable-entry\n \t\t\t\t " align="left" valign="\n \t\t\t\t\ttop\n \t\t\t\t">18 \t\t\t\t\t\t\n \t\t\t\t</td></tr></tbody></table> """ ] "imagenFichero" => array:1 [ 0 => "xTab2552398.png" ] ] ] "notaPie" => array:1 [ 0 => array:3 [ "identificador" => "tblfn0005" "etiqueta" => "*" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">The subtype is only available in 131 HIV-2 patients.</p>" ] ] ] "descripcion" => array:1 [ "en" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">General characteristics of patients with HIV-2 infection in Spain (1989–2019).</p>" ] ] 5 => array:5 [ "identificador" => "upi0005" "tipo" => "MULTIMEDIAECOMPONENTE" "mostrarFloat" => false "mostrarDisplay" => true "Ecomponente" => array:2 [ "fichero" => "mmc1.doc" "ficheroTamanyo" => 16717 ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:31 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Epidemiological aspects and world distribution of HTLV-1 infection" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "A. 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Journal Information
Vol. 156. Issue 6.
Pages 290-296 (March 2021)
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Vol. 156. Issue 6.
Pages 290-296 (March 2021)
Special article
Current epidemiological status of HIV-2 and HTLV-1 infection in Spain
Situación epidemiológica actual de la infección por VIH-2 y HTLV-1 en España
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152
Carmen de Mendozaa,
, José Manuel Ramosb, Estrella Caballeroc, Vicente Sorianod, on behalf of the Spanish HTLV and HIV-2 Study Group ◊
Corresponding author
a Instituto de Investigación Sanitaria Puerta de Hierro Majadahonda-Segovia de Arana Majadahonda, Madrid, Spain
b Hospital General Universitario de Alicante and Universidad Miguel Hernádez, Alicante, Spain
c Hospital Universitario Vall d’Hebrón, Barcelona, Spain
d Facultad de Ciencias de la Salud y Centro Médico, UNIR, Madrid, Spain
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