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Enfermedad arterial periférica asintomática estimada mediante el índice tobillo-brazo en pacientes con infección por el VIH: prevalencia y factores de riesgo asociados
Asymptomatic peripheral arterial disease detected by the ankle-brachial index in HIV-infected patients: prevalence and associated risk factors
Eduardo Canalejoa,
Autor para correspondencia
ecanalejo@gmail.com

Autor para correspondencia.
, Noemí Cabelloa, Isabel Peralesb, Sonia Allodic, Aquilino Sánchez-Purificaciónb
a Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
b Servicio de Medicina Interna, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
c Servicio de Diagnóstico por Imagen, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La enfermedad cardiovascular se ha convertido en una causa importante de morbilidad y mortalidad en los pacientes infectados por el virus de la inmunodeficiencia humana &#40;VIH&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; La introducci&#243;n del tratamiento antirretroviral de gran actividad &#40;TARGA&#41; ha conseguido disminuir dr&#225;sticamente la mortalidad relacionada con la infecci&#243;n por VIH&#59; sin embargo&#44; el aumento de la supervivencia de los pacientes&#44; la elevada prevalencia de los factores de riesgo cardiovascular &#40;FRCV&#41; tradicionales<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> y las alteraciones metab&#243;licas producidas por los f&#225;rmacos antirretrovirales &#40;dislipidemia&#44; resistencia a la insulina&#44; lipodistrofia&#41; han contribuido a un incremento del riesgo cardiovascular &#40;RCV&#41; en esta poblaci&#243;n<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;4</span></a>&#46; Adem&#225;s&#44; tanto la propia infecci&#243;n por VIH &#40;inflamaci&#243;n cr&#243;nica&#44; activaci&#243;n inmunitaria&#44; disfunci&#243;n endotelial&#41;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#8211;7</span></a> como el TARGA se han asociado al desarrollo de aterosclerosis subcl&#237;nica prematura y a una mayor incidencia de episodios cardiovasculares que en la poblaci&#243;n general<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;9</span></a>&#46; La aterosclerosis subcl&#237;nica se ha investigado en estos pacientes mediante diversas t&#233;cnicas&#44; como la medida del grosor &#237;ntima-media carot&#237;deo&#44; la estimaci&#243;n de disfunci&#243;n endotelial mediante dilataci&#243;n mediada por el flujo o la detecci&#243;n de calcificaciones coronarias por tomograf&#237;a computarizada<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;10&#44;11</span></a>&#46; La enfermedad arterial perif&#233;rica &#40;EAP&#41; de los miembros inferiores&#44; con frecuencia asintom&#225;tica hasta estadios avanzados&#44; es un indicador importante de aterosclerosis sist&#233;mica y un potente predictor de muerte por causas cardiovasculares en la poblaci&#243;n general<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a>&#46; El &#237;ndice tobillo-brazo &#40;ITB&#41; es una t&#233;cnica no invasiva&#44; sencilla y barata para el diagn&#243;stico de EAP de los miembros inferiores y una herramienta &#250;til para la predicci&#243;n de RCV&#46; A diferencia de otros m&#233;todos diagn&#243;sticos de aterosclerosis subcl&#237;nica&#44; como el grosor &#237;ntima-media carot&#237;deo&#44; no precisa personal especialmente cualificado y permite la detecci&#243;n de EAP asintom&#225;tica y la estratificaci&#243;n de su gravedad&#46; Tradicionalmente&#44; se acepta que un ITB &#8804; 0&#44;90&#44; medido en reposo&#44; es diagn&#243;stico de EAP y un indicador fiable de aterosclerosis oclusiva en las arterias principales de las extremidades inferiores &#40;sensibilidad del 79&#37; y especificidad del 96&#37; para la detecci&#243;n de estenosis &#8805;<span class="elsevierStyleHsp" style=""></span>50&#37;&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Los valores de ITB &#62; 1&#44;30 tambi&#233;n se consideran patol&#243;gicos<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; aunque se relacionan con arterias no compresibles &#40;calcificaci&#243;n o rigidez de la pared vascular&#41;&#44; y no parecen indicar una verdadera estenosis ateroscler&#243;tica&#46; En la poblaci&#243;n general&#44; se ha demostrado que tanto los valores bajos &#40;&#8804; 0&#44;90&#41; como los valores altos &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41; de ITB se asocian a un aumento de la mortalidad global y de origen cardiovascular<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">La prevalencia de EAP en la poblaci&#243;n general oscila entre un 3 y un 20&#37;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#44; dependiendo fundamentalmente de la edad&#44; la definici&#243;n de EAP y los FRCV asociados&#46; En individuos de mediana edad &#40;40-70 a&#241;os&#41;&#44; varios estudios epidemiol&#243;gicos han descrito una prevalencia de EAP&#44; definida como un ITB &#8804; 0&#44;90&#44; de entre un 3 y un 10&#44;5&#37;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;22</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">La EAP ha sido escasamente evaluada en pacientes con infecci&#243;n por VIH y su frecuencia real se desconoce&#46; Hasta la fecha&#44; tan solo unos pocos estudios han investigado la prevalencia de EAP en esta poblaci&#243;n mediante la medici&#243;n del ITB y los resultados han sido dispares<a class="elsevierStyleCrossRefs" href="#bib0115"><span class="elsevierStyleSup">23&#8211;30</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La detecci&#243;n de EAP subcl&#237;nica mediante el ITB puede ser una estrategia sencilla y &#250;til para mejorar la estratificaci&#243;n del RCV en los pacientes infectados por el VIH&#44; y permitir&#237;a la adopci&#243;n temprana de medidas terap&#233;uticas en&#233;rgicas para el control de los FRCV&#46; El objetivo del presente estudio fue determinar la prevalencia de EAP subcl&#237;nica&#44; estimada mediante el c&#225;lculo del ITB&#44; en una serie de pacientes consecutivos con infecci&#243;n por el VIH&#44; y evaluar los factores de riesgo asociados al desarrollo de EAP en esta poblaci&#243;n&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Pacientes y m&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Estudio epidemiol&#243;gico transversal de los pacientes con infecci&#243;n por VIH atendidos de forma consecutiva en la Unidad de Enfermedades Infecciosas del Hospital Universitario de Fuenlabrada &#40;Madrid&#41; en el periodo comprendido entre noviembre de 2008 y diciembre de 2009&#46; Se incluyeron los pacientes de edad superior a 20 a&#241;os que no presentaban s&#237;ntomas de claudicaci&#243;n intermitente&#44; seg&#250;n el cuestionario de Edimburgo<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">31</span></a>&#46; Fueron criterios de exclusi&#243;n el diagn&#243;stico previo de EAP y el consumo activo de drogas por v&#237;a parenteral en los &#250;ltimos 3 meses&#46; A todos los participantes en el estudio se les realiz&#243; un examen f&#237;sico que inclu&#237;a peso&#44; talla&#44; &#237;ndice de masa corporal &#40;IMC&#41; y medici&#243;n de la presi&#243;n arterial&#59; una anal&#237;tica sangu&#237;nea tras ayuno de 12 h&#59; y la determinaci&#243;n del ITB en reposo&#46; Se determinaron la glucosa&#44; la creatinina&#44; el colesterol total&#44; el colesterol unido a las lipoprote&#237;nas de baja densidad &#40;cLDL&#41;&#44; el colesterol unido a las lipoprote&#237;nas de alta densidad &#40;cHDL&#41;&#44; los triglic&#233;ridos&#44; el recuento de linfocitos CD4 y la carga viral del VIH&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Las concentraciones plasm&#225;ticas de glucosa&#44; creatinina&#44; l&#237;pidos y lipoprote&#237;nas se determinaron mediante m&#233;todos enzim&#225;ticos colorim&#233;tricos en un autoanalizador&#46; El cLDL se calcul&#243; utilizando la f&#243;rmula de Friedewald&#44; excepto cuando la cifra de triglic&#233;ridos era mayor de 400<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; en cuyo caso se midi&#243; directamente &#40;ultracentrifugaci&#243;n de lipoprote&#237;nas&#41;&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se evaluaron los FRCV tradicionales seg&#250;n las recomendaciones del Panel III del <span class="elsevierStyleItalic">National Cholesterol Education Program</span> &#40;NCEP&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; incluyendo edad &#40;hombres &#8805; 45 a&#241;os&#59; mujeres &#8805; 55 a&#241;os&#41;&#44; historia familiar de enfermedad coronaria prematura &#40;familiar de primer grado &#60;<span class="elsevierStyleHsp" style=""></span>55 a&#241;os si es hombre y &#60;<span class="elsevierStyleHsp" style=""></span>65 a&#241;os si es mujer&#41;&#44; tabaquismo &#40;fumador activo o ex fumador de menos de un a&#241;o&#41;&#44; diabetes&#44; hipertensi&#243;n arterial &#40;HTA&#41; y dislipidemia&#46; El diagn&#243;stico de diabetes mellitus se estableci&#243; cuando la glucemia en ayunas fue &#8805; 126<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; o bien&#44; si el paciente hab&#237;a sido diagnosticado previamente o estaba recibiendo tratamiento hipoglucemiante&#46; Se consider&#243; hipertenso a todo paciente con una presi&#243;n arterial &#8805; 140&#47;90<span class="elsevierStyleHsp" style=""></span>mmHg&#44; con diagn&#243;stico previo o que recib&#237;a f&#225;rmacos antihipertensivos&#46; La dislipidemia se defini&#243; como una concentraci&#243;n de colesterol total &#8805; 240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; cHDL &#60; 40<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; cLDL &#8805; 160<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; triglic&#233;ridos &#62; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#44; o tratamiento activo con hipolipemiantes&#46; La hipercolesterolemia &#40;colesterol total &#8805; 240<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; y la hipertrigliceridemia &#40;triglic&#233;ridos &#62; 200<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; se evaluaron tambi&#233;n de forma independiente&#44; incluyendo en la definici&#243;n el diagn&#243;stico establecido previamente y el uso de hipolipemiantes&#46; El IMC se calcul&#243; dividiendo el peso en kilogramos por la talla en metros cuadrados &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41; y se clasific&#243; en 3 categor&#237;as&#58; normal &#40;&#60;<span class="elsevierStyleHsp" style=""></span>25&#44;0&#41;&#44; sobrepeso &#40;25&#44;0-29&#44;9&#41; y obesidad &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>30&#44;0&#41;&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">En relaci&#243;n con la infecci&#243;n por el VIH&#44; se evaluaron el recuento de linfocitos CD4 y la carga viral en el momento del estudio&#44; el grupo de riesgo de transmisi&#243;n de la enfermedad&#44; el estadio cl&#237;nico e inmunol&#243;gico &#40;categor&#237;as de linfocitos CD4&#41; en el momento del estudio seg&#250;n la clasificaci&#243;n de los <span class="elsevierStyleItalic">Centers for Disease Control and Prevention</span> &#40;CDC&#41; de 1993&#44; el tiempo transcurrido desde el diagn&#243;stico de la infecci&#243;n y el tiempo acumulado bajo tratamiento antirretroviral &#40;TAR&#41;&#46; Se consideraron tambi&#233;n la historia de exposici&#243;n a antirretrovirales y a inhibidores de proteasa &#40;IP&#41;&#44; y la presencia o no de coinfecci&#243;n por los virus de la hepatitis B &#40;VHB&#41; y C &#40;VHC&#41;&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">La medici&#243;n del ITB se efectu&#243; con ayuda de un eco-Doppler port&#225;til bidireccional de 8<span class="elsevierStyleHsp" style=""></span>MHz y de un esfigmoman&#243;metro de mercurio calibrado&#46; Tras un periodo de reposo de 5<span class="elsevierStyleHsp" style=""></span>min&#44; se midi&#243; la presi&#243;n arterial sist&#243;lica &#40;PAS&#41; en la arteria braquial de ambos miembros superiores y en las arterias tibial posterior y pedia de ambos miembros inferiores&#46; El valor del ITB para cada uno de los miembros inferiores se calcul&#243; dividiendo la PAS m&#225;s alta de las 2 obtenidas en cada tobillo &#40;tibial posterior o pedia&#41; entre la PAS m&#225;s alta de las obtenidas en ambos brazos&#46; Se consider&#243; patol&#243;gico un ITB &#8804; 0&#44;90 &#40;bajo&#41; o un ITB &#62; 1&#44;40 &#40;alto&#41; en cualquiera de los miembros inferiores&#44; y normal un ITB &#62; 0&#44;90 y &#8804; 1&#44;40 en ambos miembros inferiores&#46; La EAP se defini&#243; como un ITB bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;90&#41;&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En los pacientes con ITB bajo se investig&#243; la presencia de lesiones ateroscler&#243;ticas mediante ecograf&#237;a d&#250;plex-Doppler color arterial de ambos miembros inferiores &#40;ec&#243;grafo LOGIC 7&#44; GE Healthcare&#41;&#46; Se evaluaron los sectores aortoil&#237;aco&#44; femoropopl&#237;teo y tibioperoneo&#46; Las placas se definieron como engrosamientos focales del espesor &#237;ntima-media &#62; 1&#44;2<span class="elsevierStyleHsp" style=""></span>mm o superiores al 50&#37; del espesor &#237;ntima-media adyacente&#46; El porcentaje de estenosis se calcul&#243; mediante el cociente de velocidad pico sist&#243;lica estenosis&#47;preestenosis&#46; Todas las exploraciones fueron realizadas por un &#250;nico especialista&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">El estudio fue aprobado por el Comit&#233; de &#201;tica e Investigaci&#243;n Cl&#237;nica de nuestra &#225;rea sanitaria y todos los pacientes firmaron un documento de consentimiento informado&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">An&#225;lisis estad&#237;stico</span><p id="par0060" class="elsevierStylePara elsevierViewall">Se ha realizado un an&#225;lisis descriptivo de todos los par&#225;metros recogidos&#44; que incluye media y desviaci&#243;n est&#225;ndar o&#44; en caso de asimetr&#237;a&#44; mediana y rango intercuart&#237;lico &#40;RIC&#41;&#44; as&#237; como frecuencias absolutas y relativas para las variables cualitativas&#46; Para la comparaci&#243;n de variables cuantitativas se utiliz&#243; el test de la t de Student o el test de la mediana&#46; Para la comparaci&#243;n de variables cualitativas el test de la &#967;<span class="elsevierStyleSup">2</span> o el test exacto de Fisher&#46; Los valores &#171;perdidos&#187; &#40;datos ausentes en el cuaderno de recogida de datos&#41; no se contabilizaron para el c&#225;lculo de porcentajes&#46; La asociaci&#243;n entre FRCV y factores relacionados con la infecci&#243;n por VIH y la EAP se evalu&#243; mediante an&#225;lisis univariable y multivariable&#46; El ITB bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;90&#41; se us&#243; para definir la EAP&#44; y fue la &#250;nica variable dependiente utilizada en el an&#225;lisis&#46; Solo hubo un caso de ITB alto &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41;&#44; que no se incluy&#243; en el an&#225;lisis&#46; Para el an&#225;lisis multivariable se ajust&#243; un modelo de regresi&#243;n log&#237;stica en el que se incluyeron como variables independientes aquellas que en el an&#225;lisis univariable obtuvieron un valor de p &#60; 0&#44;10 &#40;diabetes mellitus&#44; HTA&#44; hipertrigliceridemia&#44; hipercolesterolemia&#44; IMC&#44; estadio cl&#237;nico C de los CDC&#41; y las que se consideraron cl&#237;nicamente relevantes&#44; evaluando la confusi&#243;n que una variable produce en el modelo cuando est&#225; y cuando no est&#225;&#46; Se calcularon las <span class="elsevierStyleItalic">odds ratio</span> &#40;OR&#41; univariables y ajustadas &#40;ORaj&#41; junto a sus intervalos de confianza &#40;IC&#41; del 95&#37;&#46; El an&#225;lisis estad&#237;stico se realiz&#243; con el programa SPSS versi&#243;n 15&#46;0 para Windows &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; Estados Unidos&#41; y el programa Stata versi&#243;n 9&#46;0&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><p id="par0065" class="elsevierStylePara elsevierViewall">Entre noviembre de 2008 y diciembre de 2009 un total de 205 pacientes fueron incluidos en el estudio&#44; con una edad media de 41<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>9 a&#241;os y predominio del sexo masculino &#40;66&#44;8&#37;&#41;&#46; Las caracter&#237;sticas cl&#237;nicas y demogr&#225;ficas de los pacientes se muestran en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; La proporci&#243;n de inmigrantes en la poblaci&#243;n de estudio era del 30&#44;2&#37;&#44; la mayor&#237;a procedentes del &#193;frica Subsahariana&#44; con un 10&#44;2&#37; de hipertensos&#46; El grupo de riesgo m&#225;s numeroso fue el heterosexual &#40;43&#44;9&#37;&#41;&#46; La prevalencia de FRCV tradicionales entre los pacientes incluidos era elevada&#44; con una mediana de 2 &#40;RIC 1-3&#41; por paciente&#46; Un 27&#44;8&#37; ten&#237;an &#8805; 3 FRCV&#44; siendo el tabaquismo &#40;63&#44;9&#37;&#41; y la dislipidemia &#40;60&#44;1&#37;&#41; los m&#225;s prevalentes&#46; Con respecto a las caracter&#237;sticas de la infecci&#243;n por VIH&#44; 106 &#40;52&#37;&#41; pacientes presentaban unos linfocitos CD4 nadir &#60; 200 c&#233;l&#46;&#47;&#956;l y solo 34 &#40;16&#44;7&#37;&#41; ten&#237;an un recuento actual de CD4 &#60; 200 c&#233;l&#46;&#47;&#956;l&#46; La carga viral era indetectable en menos de la mitad de los casos &#40;45&#44;8&#37;&#41;&#46; En el momento del estudio 150 &#40;73&#44;2&#37;&#41; pacientes recib&#237;an TAR y 39 &#40;19&#37;&#41; no hab&#237;an recibido tratamiento previamente&#46; La exposici&#243;n a TAR se hab&#237;a producido en 166 &#40;81&#37;&#41; pacientes durante una mediana de tiempo de 3&#44;0 a&#241;os &#40;RIC 1&#44;0-8&#44;0&#41; y 101 &#40;49&#44;3&#37;&#41; hab&#237;an sido tratados con IP&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La prevalencia de EAP subcl&#237;nica &#40;ITB &#8804; 0&#44;90&#41; en la poblaci&#243;n de estudio fue del 6&#44;3&#37; &#40;IC 95&#37; 2&#44;8-9&#44;9&#37;&#59; n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46; Tan solo hubo un caso de ITB alto &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41;&#46; Mediante ecograf&#237;a d&#250;plex se evaluaron las principales arterias de miembros inferiores en 10 de los 13 pacientes con ITB bajo&#44; hall&#225;ndose lesiones ateroscler&#243;ticas en todos ellos&#46; En la <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a> se exponen las caracter&#237;sticas de los 13 pacientes con un ITB bajo&#46; Los pacientes con EAP ten&#237;an una edad media de 45<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>14 a&#241;os&#44; y todos&#44; excepto uno&#44; hab&#237;an recibido TAR&#44; 8 de ellos &#40;61&#44;5&#37;&#41; con IP&#46; La mediana de tiempo de exposici&#243;n a los antirretrovirales era de 4&#44;0 a&#241;os &#40;RIC 2&#44;0-8&#44;0&#41;&#46; La carga viral era indetectable en 8 &#40;61&#44;5&#37;&#41; y tan solo 2 ten&#237;an un recuento actual de linfocitos CD4 &#60; 200 c&#233;l&#46;&#47;&#956;l&#44; aunque 9 &#40;69&#44;2&#37;&#41; presentaban una cifra nadir de CD4 &#60; 200 c&#233;l&#46;&#47;&#956;l&#46; Cinco de los 13 pacientes &#40;38&#44;5&#37;&#41; ten&#237;an &#8805; 3 FRCV y solo 3 &#40;23&#44;1&#37;&#41; presentaban un RCV a 10 a&#241;os &#62; 20&#37; calculado mediante la ecuaci&#243;n de Framingham<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0075" class="elsevierStylePara elsevierViewall">Al comparar los grupos de ITB bajo y normal mediante un an&#225;lisis univariable &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#44; se encontr&#243; una proporci&#243;n significativamente mayor de hipercolesterolemia &#40;OR 3&#44;97&#59; IC 95&#37; 1&#44;21-13&#44;06&#41;&#44; HTA &#40;OR 4&#44;55&#59; IC 95&#37; 1&#44;27-16&#44;34&#41; y diabetes mellitus &#40;OR 6&#44;07&#59; IC 95&#37; 1&#44;42-25&#44;95&#41; en los pacientes con ITB bajo&#46; Tambi&#233;n el IMC fue significativamente mayor en el grupo de ITB bajo &#40;27&#44;7 vs&#46; 25&#44;0&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;044&#41;&#44; con una proporci&#243;n m&#225;s elevada de sobrepeso &#40;OR 4&#44;06&#59; IC 95&#37; 0&#44;93-17&#44;67&#41; y obesidad &#40;OR 7&#44;50&#59; IC 95&#37; 1&#44;69-33&#44;38&#41;&#46; De los factores relacionados con la infecci&#243;n por VIH&#44; la exposici&#243;n a TAR &#40;OR 2&#44;98&#59; IC 95&#37; 0&#44;38-23&#44;64&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;469&#41;&#44; el estadio cl&#237;nico C de los CDC &#40;OR 2&#44;45&#59; IC 95&#37; 0&#44;71-8&#44;42&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;100&#41; y unos linfocitos CD4 nadir &#60; 200 c&#233;l&#46;&#47;&#956;l &#40;OR 2&#44;20&#59; IC 95&#37; 0&#44;66-7&#44;40&#59; p<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>0&#44;192&#41; se asociaron a ITB bajo&#44; aunque estas asociaciones no fueron estad&#237;sticamente significativas&#46; Otros factores como el recuento actual de linfocitos CD4&#44; la carga viral&#44; la exposici&#243;n a IP&#44; el tiempo acumulado de TAR o la antig&#252;edad de la infecci&#243;n por VIH&#44; no se correlacionaron con el ITB bajo&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0080" class="elsevierStylePara elsevierViewall">En el an&#225;lisis multivariable &#40;<a class="elsevierStyleCrossRef" href="#tbl0020">tabla 4</a>&#41;&#44; los &#250;nicos factores asociados de forma independiente con la presencia de EAP fueron el sobrepeso &#40;ORaj 4&#44;21&#59; IC 95&#37; 1&#44;00-18&#44;78&#41;&#44; la obesidad &#40;ORaj 5&#44;76&#59; IC 95&#37; 1&#44;17-28&#44;37&#41; y el estadio cl&#237;nico C de la infecci&#243;n por VIH &#40;ORaj 2&#44;95&#59; IC 95&#37; 1&#44;00-9&#44;83&#41;&#46; La diabetes mellitus tambi&#233;n permaneci&#243; en el modelo&#44; aunque la asociaci&#243;n con la EAP no lleg&#243; a alcanzar significaci&#243;n estad&#237;stica &#40;ORaj 3&#44;90&#59; IC 95&#37; 0&#44;78-19&#44;55&#41;&#46;</p><elsevierMultimedia ident="tbl0020"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0085" class="elsevierStylePara elsevierViewall">Nuestro estudio muestra una prevalencia de EAP asintom&#225;tica del 6&#44;3&#37; en una cohorte de pacientes infectados por el VIH mayores de 20 a&#241;os&#44; que es similar a la descrita en la poblaci&#243;n general para individuos de mediana edad &#40;3-10&#44;5&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0095"><span class="elsevierStyleSup">19&#8211;22</span></a>&#46; Sin embargo&#44; esta prevalencia es incluso superior a la encontrada en algunos estudios epidemiol&#243;gicos poblacionales realizados con sujetos de mayor edad&#46; Por ejemplo&#44; en el estudio de Ramos et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> en Espa&#241;a&#44; que incluy&#243; a pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>35 a&#241;os&#44; la prevalencia global fue del 4&#44;5&#37;&#59; y en el estudio de Selvin et al&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> en Estados Unidos&#44; con pacientes &#8805;<span class="elsevierStyleHsp" style=""></span>40 a&#241;os&#44; la prevalencia fue del 4&#44;3&#37;&#46; Es dif&#237;cil comparar la prevalencia de EAP de nuestra poblaci&#243;n de estudio con la encontrada en otros trabajos realizados hasta la fecha en pacientes con infecci&#243;n por VIH&#44; debido a la heterogeneidad de las poblaciones incluidas y a las diferencias en la definici&#243;n de EAP&#46; No obstante&#44; si atendemos exclusivamente a la definici&#243;n de EAP como un ITB bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;90&#41;&#44; la prevalencia encontrada en nuestros pacientes es inferior a la hallada por Periard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a>&#44; Palacios et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> y Jang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a>&#44; y superior a la descrita por el resto de los estudios publicados<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#8211;29</span></a>&#46; En todos estos trabajos la edad media de los pacientes fue superior a la de los incluidos en nuestro estudio&#44; a excepci&#243;n del trabajo de Sharma et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#44; donde solo se incluyeron mujeres&#46; Jang et al&#46;<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> son los que encuentran una prevalencia m&#225;s elevada de EAP en pacientes infectados por el VIH &#40;11&#37;&#41;&#44; lo que quiz&#225; podr&#237;a justificarse por la mayor edad de la poblaci&#243;n de estudio &#40;edad media 48&#44;4 a&#241;os&#41; y por la inclusi&#243;n de pacientes con EAP sintom&#225;tica&#46; En los estudios de Periard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> y Palacios et al&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> tambi&#233;n se incluyeron pacientes de mayor edad &#40;&#8805;<span class="elsevierStyleHsp" style=""></span>40 y &#62;<span class="elsevierStyleHsp" style=""></span>50 a&#241;os&#44; respectivamente&#41; y sintom&#225;ticos&#44; por lo que la prevalencia de EAP observada por ellos no es f&#225;cilmente comparable con la detectada en nuestra serie&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">A diferencia de algunos trabajos que han mostrado una elevada prevalencia de ITB alto en pacientes infectados por el VIH<a class="elsevierStyleCrossRefs" href="#bib0130"><span class="elsevierStyleSup">26&#8211;30</span></a>&#44; nosotros hemos encontrado tan solo un caso de ITB &#62; 1&#44;40&#46; Esta baja prevalencia de ITB alto es dif&#237;cil de explicar&#44; aunque podr&#237;an influir la menor edad de nuestra cohorte&#44; la elecci&#243;n de un punto de corte de ITB m&#225;s elevado que en otros estudios &#40;1&#44;40 vs&#46; 1&#44;30&#41; y la exclusi&#243;n de pacientes con s&#237;ntomas de EAP&#46; De todas formas&#44; conviene recordar que&#44; aunque un ITB &#62; 1&#44;40 se ha asociado a un aumento de la mortalidad en la poblaci&#243;n no infectada<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#8211;17</span></a>&#44; solo el ITB bajo es un indicador fiable de aterosclerosis sist&#233;mica y EAP&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">El sobrepeso &#40;IMC 25&#44;0-29&#44;9&#41;&#44; la obesidad &#40;IMC &#8805; 30&#44;0&#41; y el estadio cl&#237;nico C de la infecci&#243;n por VIH &#40;criterios definitorios de sida&#41; fueron los &#250;nicos factores que se asociaron de forma independiente a la EAP demostrada mediante un ITB bajo en nuestro estudio&#46; Dentro de los FRCV tradicionales&#44; la HTA&#44; la hipercolesterolemia y la diabetes mellitus se relacionaron tambi&#233;n con la EAP en esta poblaci&#243;n&#44; pero tal asociaci&#243;n no lleg&#243; a ser significativa en el an&#225;lisis multivariable&#44; quiz&#225; debido al reducido tama&#241;o muestral&#46; Aunque el 63&#44;9&#37; de nuestros pacientes eran fumadores&#44; el tabaquismo no se identific&#243; como factor de riesgo de EAP en esta serie&#46; Esto&#44; sin embargo&#44; coincide con lo observado en otros trabajos previos<a class="elsevierStyleCrossRefs" href="#bib0120"><span class="elsevierStyleSup">24&#44;27&#44;28&#44;30</span></a> e indica que&#44; independientemente de los FRCV tradicionales&#44; la propia infecci&#243;n por VIH podr&#237;a contribuir al desarrollo de EAP en esta poblaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La prevalencia de sobrepeso y obesidad en los pacientes con EAP fue muy elevada &#40;77&#37;&#41;&#44; en comparaci&#243;n con aquellos que presentaron un ITB normal &#40;38&#44;7&#37;&#41;&#44; lo que constituye una diferencia importante con anteriores estudios realizados en pacientes infectados por el VIH&#46; Tan solo Sharma et al&#46;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> hallaron una asociaci&#243;n significativa entre sobrepeso e ITB alto&#44; aunque tal asociaci&#243;n no pudo demostrarse en el grupo de ITB bajo&#44; debido a su baja prevalencia &#40;0&#44;9&#37;&#41;&#46; Tanto la obesidad como el sobrepeso se han relacionado con la EAP en sujetos no infectados por el VIH<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">34&#8211;36</span></a>&#44; aunque no son factores de riesgo establecidos de EAP&#44; como edad&#44; tabaquismo&#44; HTA&#44; diabetes o hipercolesterolemia<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">14&#44;19</span></a>&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">En series previas de pacientes infectados por el VIH&#44; Periard et al&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a> identificaron el recuento bajo de linfocitos CD4 &#40;&#60; 200 c&#233;l&#46;&#47;&#956;l&#41; como factor de riesgo independiente de EAP&#44; mientras que Olalla et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> y Salas et al&#46;<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a> hallaron una asociaci&#243;n estad&#237;sticamente significativa entre el uso de IP y la presencia de un ITB alterado&#46; En nuestro estudio&#44; solo el estadio cl&#237;nico C de la infecci&#243;n por VIH &#40;criterios definitorios de sida&#41; se ha mostrado como predictor independiente de EAP&#44; y no hemos encontrado una asociaci&#243;n significativa entre la presencia de ITB bajo y el resto de los factores relacionados con la infecci&#243;n por VIH&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Las principales limitaciones del presente estudio son su reducido tama&#241;o muestral y la falta de un grupo control de pacientes no infectados&#46; La inclusi&#243;n de un n&#250;mero relativamente elevado de pacientes no tratados previamente <span class="elsevierStyleItalic">&#40;na&#239;ve&#41;</span> &#40;19&#37;&#41; y con interrupci&#243;n del tratamiento &#40;7&#44;8&#37;&#41; en nuestra serie&#44; podr&#237;a haber influido en la prevalencia de EAP encontrada&#44; limitando&#44; incluso&#44; la capacidad del estudio para detectar una posible asociaci&#243;n con el TAR&#46; Se necesitar&#237;an estudios epidemiol&#243;gicos m&#225;s amplios&#44; con grupos m&#225;s homog&#233;neos y con seguimiento a largo plazo para caracterizar mejor los factores de riesgo de EAP subcl&#237;nica y determinar su pron&#243;stico en pacientes infectados por el VIH&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; los resultados de este estudio revelan que la prevalencia de EAP subcl&#237;nica en pacientes infectados por el VIH es similar a la de la poblaci&#243;n general no infectada&#46; Sin embargo&#44; si tenemos en cuenta que la EAP es claramente dependiente de la edad<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> y que la mayor&#237;a de los estudios epidemiol&#243;gicos que han evaluado la prevalencia de EAP en la poblaci&#243;n general incluyeron individuos de mayor edad que la de los participantes en nuestro estudio&#44; la prevalencia observada puede considerarse elevada&#46; El sobrepeso&#44; la obesidad y el estadio cl&#237;nico avanzado de la infecci&#243;n por VIH &#40;estadio C de los CDC&#41; se asociaron significativamente con un ITB bajo y comportan un mayor riesgo de EAP en esta poblaci&#243;n&#46; En los pacientes infectados por VIH&#44; la detecci&#243;n de un ITB bajo identifica a sujetos con alto RCV y justifica la instauraci&#243;n de medidas en&#233;rgicas para el control &#243;ptimo de los FRCV&#44; e incluso la utilizaci&#243;n de antiagregantes&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0120" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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          "titulo" => array:5 [
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        2 => array:2 [
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          "titulo" => array:5 [
            0 => "Abstract"
            1 => "Introduction"
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          "titulo" => "Introducci&#243;n"
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        5 => array:2 [
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          "titulo" => "Pacientes y m&#233;todos"
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          "titulo" => "An&#225;lisis estad&#237;stico"
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          "titulo" => "Resultados"
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          "titulo" => "Discusi&#243;n"
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          "titulo" => "Conflicto de intereses"
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        10 => array:2 [
          "identificador" => "xack42225"
          "titulo" => "Agradecimientos"
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        11 => array:1 [
          "titulo" => "Bibliograf&#237;a"
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    "pdfFichero" => "main.pdf"
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    "fechaRecibido" => "2010-12-13"
    "fechaAceptado" => "2011-07-06"
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          "titulo" => "Palabras clave"
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          "palabras" => array:4 [
            0 => "VIH"
            1 => "Enfermedad arterial perif&#233;rica"
            2 => "&#205;ndice tobillo-brazo"
            3 => "Riesgo cardiovascular"
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        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec138643"
          "palabras" => array:4 [
            0 => "HIV"
            1 => "Peripheral arterial disease"
            2 => "Ankle-brachial index"
            3 => "Cardiovascular risk"
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    "resumen" => array:2 [
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        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">La infecci&#243;n por el virus de la inmunodeficiencia humana &#40;VIH&#41; se ha asociado a un mayor riesgo de aterosclerosis subcl&#237;nica y de episodios cardiovasculares&#46; La enfermedad arterial perif&#233;rica &#40;EAP&#41; es un buen marcador de aterosclerosis sist&#233;mica y un importante predictor de morbilidad y mortalidad de origen cardiovascular&#46; El objetivo de este estudio fue determinar la prevalencia de EAP asintom&#225;tica y los factores de riesgo asociados en los pacientes infectados por el VIH&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio transversal de los pacientes infectados por el VIH mayores de 20 a&#241;os&#44; sin s&#237;ntomas de claudicaci&#243;n intermitente&#44; atendidos de forma consecutiva en nuestra unidad entre noviembre de 2008 y diciembre de 2009&#46; Se evalu&#243; la presencia de EAP mediante la determinaci&#243;n del &#237;ndice tobillo-brazo &#40;ITB&#41; en reposo&#46; La EAP se defini&#243; como un ITB &#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;90&#46; Se registraron las caracter&#237;sticas cl&#237;nico-epidemiol&#243;gicas de la infecci&#243;n por VIH y los factores de riesgo cardiovascular &#40;FRCV&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron 205 pacientes &#40;66&#44;8&#37; varones&#41;&#44; con una edad media de 41 a&#241;os y una mediana de 2 FRCV &#40;63&#44;9&#37; tabaquismo&#41;&#46; La prevalencia de EAP detectada mediante ITB bajo &#40;&#8804;<span class="elsevierStyleHsp" style=""></span>0&#44;90&#41; fue del 6&#44;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46; Tan solo hubo un caso de ITB alto &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#44;40&#41;&#46; En el an&#225;lisis multivariable&#44; los factores que se asociaron significativamente con la EAP fueron el sobrepeso &#40;<span class="elsevierStyleItalic">odds ratio</span> ajustada &#91;ORaj&#93; 4&#44;21&#59; intervalo de confianza &#91;IC&#93; del 95&#37; 1&#44;00-18&#44;78&#41;&#44; la obesidad &#40;ORaj 5&#44;76&#59; IC 95&#37; 1&#44;17-28&#44;37&#41; y el estadio cl&#237;nico C de la infecci&#243;n por VIH &#40;ORaj 2&#44;95&#59; IC 95&#37; 1&#44;00-9&#44;83&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La prevalencia de EAP asintom&#225;tica en una cohorte relativamente joven de pacientes infectados por el VIH es comparable a la observada en la poblaci&#243;n adulta de mediana edad no infectada&#46; El sobrepeso&#44; la obesidad y el estadio cl&#237;nico avanzado de la infecci&#243;n por VIH &#40;criterios definitorios de sida&#41; son factores de riesgo independientes para su desarrollo&#46;</p>"
      ]
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Human immunodeficiency virus &#40;HIV&#41; infection has been associated with a higher risk of subclinical atherosclerosis and cardiovascular events&#46; Peripheral arterial disease &#40;PAD&#41; is a good marker of systemic atherosclerosis and a powerful predictor of cardiovascular morbidity and mortality&#46; The objective of this study was to determine the prevalence of asymptomatic PAD and associated risk factors in HIV-infected people&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Cross-sectional study was conducted on all consecutive HIV-positive patients older than 20 years without symptoms of intermittent claudication who attended our clinic between November 2008 and December 2009&#46; PAD was assessed by measuring the ankle-brachial index &#40;ABI&#41; at rest&#46; To define PAD&#44; an ABI &#8804; 0&#46;90 was used&#46; Main epidemiological and clinical characteristics of the HIV infection and cardiovascular risk factors &#40;CVRF&#41; were recorded&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Two hundred and five patients were evaluated &#40;66&#46;8&#37; male&#41;&#44; with a mean age of 41 years and there was a median of 2 CVRF &#40;63&#46;9&#37; smokers&#41;&#46; Prevalence of asymptomatic PAD &#40;ABI &#8804;<span class="elsevierStyleHsp" style=""></span>0&#46;90&#41; was 6&#46;3&#37; &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&#46; There was only 1 patient with a high ABI &#40;&#62;<span class="elsevierStyleHsp" style=""></span>1&#46;40&#41;&#46; In the multivariate analysis&#44; factors significantly associated with PAD were overweight &#40;adjusted <span class="elsevierStyleItalic">odds ratio</span> &#91;ORadj&#93; 4&#46;21&#59; 95&#37; confidence interval &#91;CI&#93; 1&#46;00-18&#46;78&#41;&#44; obesity &#40;ORadj 5&#46;76&#59; 95&#37; CI 1&#46;17-28&#46;37&#41; and clinical stage C of HIV infection &#40;ORadj 2&#46;95&#59; 95&#37; CI 1&#46;00-9&#46;83&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Prevalence of asymptomatic PAD in a relatively young HIV-infected cohort is similar to that observed in the uninfected middle-aged adult population&#46; Overweight&#44; obesity and advanced clinical stage of HIV infection &#40;AIDS-defining conditions&#41; were identified as independent risk factors for PAD&#46;</p>"
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          "leyenda" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">CDC&#58; <span class="elsevierStyleItalic">Centers for Disease Control and Prevention&#59;</span> DE&#58; desviaci&#243;n est&#225;ndar&#59; EC&#58; enfermedad coronaria&#59; HTA&#58; hipertensi&#243;n arterial&#59; IMC&#58; &#237;ndice de masa corporal&#59; IP&#58; inhibidores de proteasa&#59; ITB&#58; &#237;ndice tobillo-brazo&#59; RI&#58; rango intercuart&#237;lico&#59; TAR&#58; tratamiento antirretroviral&#59; TV&#58; transmisi&#243;n vertical&#59; UDVP&#58; usuario de drogas por v&#237;a parenteral&#59; VHB&#58; virus de la hepatitis B&#59; VHC&#58; virus de la hepatitis C&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">CDC&#58; <span class="elsevierStyleItalic">Centers for Disease Control and Prevention&#59;</span> CV&#58; carga viral&#59; DL&#58; dislipidemia&#59; DM&#58; diabetes mellitus&#59; EAP&#58; enfermedad arterial perif&#233;rica&#59; EC&#58; enfermedad coronaria&#59; FRCV&#58; factores de riesgo cardiovascular&#59; GR&#58; grupo de riesgo&#59; HMS&#58; homosexual&#59; HTA&#58; hipertensi&#243;n arterial&#59; HTS&#58; heterosexual&#59; IMC&#58; &#237;ndice de masa corporal&#59; ITB&#58; &#237;ndice tobillo-brazo&#59; M&#58; mujer&#59; NR&#58; no realizado&#59; RCV&#58; riesgo cardiovascular a 10 a&#241;os &#40;ecuaci&#243;n Framingham&#41;&#59; TAR&#58; tratamiento antirretroviral&#59; TV&#58; transmisi&#243;n vertical&#59; UDVP&#58; usuario de drogas por v&#237;a parenteral&#59; V&#58; var&#243;n&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">GR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">FRCV&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">RCV &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ITB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">CD4 &#40;c&#233;l&#46;&#47;&#956;l&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">CV &#40;log<span class="elsevierStyleInf">10</span>c&#47;ml&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Estadios CDC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">TAR &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">Duraci&#243;n de la infecci&#243;n VIH &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \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">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">28&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabaquismo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">522&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">4&#44;16&nbsp;\t\t\t\t\t\t\n
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                  \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">C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">3&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">5&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">36&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">30&#44;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Ninguno&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">0&#44;90&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">493&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60; 1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">A2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">6&#44;0&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">9&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">42&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">UDVP&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">23&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabaquismo&#44; DL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">1&#46;064&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">&#60; 1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">A2&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">DM&#44; HTA&#44; DL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tabaquismo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">Tabaquismo&#44; DM&#44; historia familiar EC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Tabaquismo&#44; DL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">UDVP&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabaquismo&#44; DM&#44; HTA&#44; DL&#44; historia familiar EC&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">56&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">27&#44;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabaquismo&#44; HTA&#44; DL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#62; 20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">459&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">V&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">51&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">HTS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">23&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Tabaquismo&#44; DL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">423&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60; 1&#44;60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">C3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">15&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&#44;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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              "imagenFichero" => array:1 [
                0 => "xTab244843.png"
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            1 => 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"><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Paciente&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ecograf&#237;a d&#250;plex&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Estenosis del 20&#37; bilateral en las arterias il&#237;acas comunes&#46; Aterosclerosis difusa tibial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">NR&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas ateroscler&#243;ticas en las arterias tibiales posteriores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aterosclerosis difusa aortoil&#237;aca&#44; femoropopl&#237;tea y tibial&#46; Estenosis del 40&#37; de la arteria femoral superficial derecha&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas ateroscler&#243;ticas en las arterias femorales superficiales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aterosclerosis difusa aortoil&#237;aca&#46; Placas ateroscler&#243;ticas en las arterias tibiales posteriores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas ateroscler&#243;ticas en las arterias femorales superficiales&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Placas ateroscler&#243;ticas en las arterias tibiales posteriores&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">11&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aterosclerosis difusa femoropopl&#237;tea y tibial&#46; Estenosis del 40&#37; en la arteria tibial anterior izquierda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">12&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Aterosclerosis difusa femoropopl&#237;tea y tibial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Oclusi&#243;n bilateral de las arterias il&#237;acas comunes&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
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                0 => "xTab244842.png"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas de los 13 pacientes con enfermedad arterial perif&#233;rica &#40;ITB &#8804; 0&#44;90&#41;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "tbl0015"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">CDC&#58; <span class="elsevierStyleItalic">Centers for Disease Control and Prevention&#59;</span> DE&#58; desviaci&#243;n est&#225;ndar&#59; EC&#58; enfermedad coronaria&#59; HTA&#58; hipertensi&#243;n arterial&#59; IC&#58; intervalo de confianza&#59; IMC&#58; &#237;ndice de masa corporal&#59; IP&#58; inhibidores de proteasa&#59; ITB&#58; &#237;ndice tobillo-brazo&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#59;</span> RI&#58; rango intercuart&#237;lico&#59; TAR&#58; tratamiento antirretroviral&#59; TV&#58; transmisi&#243;n vertical&#59; UDVP&#58; usuario de drogas por v&#237;a parenteral&#59; VHB&#58; virus de la hepatitis B&#59; VHC&#58; virus de la hepatitis C&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
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                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Variable&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">ITB normal &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>191&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td 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" style="border-bottom: 2px solid black">ITB &#8804; 0&#44;90 &#40;n<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>13&#41;&nbsp;\t\t\t\t\t\t\n
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                  \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" style="border-bottom: 2px solid black">OR &#40;IC 95&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">p&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo masculino&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo de riesgo&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Heterosexual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Estadio cl&#237;nico CDC&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Duraci&#243;n de la infecci&#243;n VIH &#40;a&#241;os&#41;&#44; mediana &#40;RI&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Historia familiar EC&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39 &#40;21&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;15&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;67 &#40;0&#44;14-3&#44;16&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#62; 0&#44;999&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ARN-VIH &#60; 40 copias&#47;ml&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">84 &#40;44&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">8 &#40;61&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2&#44;00 &#40;0&#44;63-6&#44;34&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">ARN-VIH &#40;log</span><span class="elsevierStyleInf"><span class="elsevierStyleItalic">10</span></span><span class="elsevierStyleItalic">copias&#47;ml&#41;&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CD4 actuales &#40;c&#233;l&#46;&#47;&#956;l&#41;&#44; mediana &#40;RI&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">418 &#40;246-599&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CD4 actuales &#60; 200 c&#233;l&#46;&#47;&#956;l&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&#62; 0&#44;999&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">CD4 nadir &#60; 200 c&#233;l&#46;&#47;ul &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">96 &#40;50&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Exposici&#243;n a TAR&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Exposici&#243;n a IP&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;351&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Tiempo acumulado TAR &#40;a&#241;os&#41;&#44; media &#40;DE&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coinfecci&#243;n VHB&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;5&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1 &#40;7&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;526&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Coinfecci&#243;n VHC&#44; n &#40;&#37;&#41;</span>&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">70 &#40;36&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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          "leyenda" => "<p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">CDC&#58; <span class="elsevierStyleItalic">Centers for Disease Control and Prevention&#59;</span> HTA&#58; hipertensi&#243;n arterial&#59; IC&#58; intervalo de confianza&#59; IMC&#58; &#237;ndice de masa corporal&#59; ITB&#58; &#237;ndice tobillo-brazo&#59; OR&#58; <span class="elsevierStyleItalic">odds ratio&#59;</span> TAR&#58; tratamiento antirretroviral&#59; VIH&#58; virus de la inmunodeficiencia humana&#46;</p><p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">El modelo incluye las siguientes variables&#58; diabetes&#44; HTA&#44; hipertrigliceridemia&#44; hipercolesterolemia&#44; estadio cl&#237;nico CDC&#44; tiempo acumulado TAR e IMC&#46;</p>"
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Estadio cl&#237;nico CDC &#40;C vs&#46; AB&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;67&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Tiempo acumulado TAR&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>IMC &#40;kg&#47;m<span class="elsevierStyleSup">2</span>&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>25-29 vs&#46; &#60; 25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;085&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3&#44;81&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0&#44;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">17&#44;51&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#8805; 30 vs&#46; &#60; 25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;104&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">4&#44;08&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">22&#44;26&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="5" align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleVsp" style="height:0.5px"></span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Diabetes &#40;s&#237; vs&#46; no&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">0&#44;099&nbsp;\t\t\t\t\t\t\n
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                            2 => "F&#46;G&#46; Fowkes"
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Información del artículo
ISSN: 0213005X
Idioma original: Español
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2019 Julio 35 25 60
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2018 Octubre 26 28 54
2018 Septiembre 29 10 39
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2018 Mayo 6 4 10
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