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y ya en 1998 se recomendaba implantar sistemas de vigilancia epidemiol&#243;gica de los nuevos diagn&#243;sticos de VIH en Europa<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#44; recomendaci&#243;n que se reflej&#243; en Espa&#241;a en la publicaci&#243;n de la orden de 18 de diciembre de 2000 por la que se creaba el Sistema de Informaci&#243;n sobre Nuevas Infecciones de VIH &#40;SINIVIH&#41;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; Algunos hechos desafortunados<a class="elsevierStyleCrossRefs" href="#bib0060"><span class="elsevierStyleSup">12&#44;13</span></a> dificultaron la implantaci&#243;n de esta norma&#44; pero una vez superadas tales circunstancias<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> est&#225; previsto que la implantaci&#243;n del SINIVIH se complete en todo el pa&#237;s a finales de 2012<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Actualmente se recoge informaci&#243;n sobre nuevos diagn&#243;sticos de VIH en las comunidades aut&#243;nomas de Arag&#243;n&#44; Asturias&#44; Baleares&#44; Canarias&#44; Cantabria&#44; Galicia&#44; Castilla y Le&#243;n&#44; Catalu&#241;a&#44; Extremadura&#44; La Rioja&#44; Madrid&#44; Navarra y Pa&#237;s Vasco&#44; y en las ciudades aut&#243;nomas de Ceuta y Melilla&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El objetivo de este trabajo es describir la incidencia de nuevos diagn&#243;sticos de VIH en 15 comunidades y ciudades aut&#243;nomas en 2009&#44; as&#237; como la tendencia durante el periodo 2004-2009 para aquellas de las que se dispone de informaci&#243;n de todo el periodo&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="par0025" class="elsevierStylePara elsevierViewall">Se incluyeron los nuevos diagn&#243;sticos de VIH del a&#241;o 2009 notificados en Arag&#243;n&#44; Asturias&#44; Baleares&#44; Canarias&#44; Cantabria&#44; Castilla y Le&#243;n&#44; Catalu&#241;a&#44; Extremadura&#44; 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pero en todas las comunidades aut&#243;nomas el personal de vigilancia epidemiol&#243;gica complement&#243; la notificaci&#243;n con la b&#250;squeda activa de nuevos diagn&#243;sticos de VIH en los laboratorios correspondientes&#46; En Asturias&#44; los laboratorios de microbiolog&#237;a que declaran al Sistema de Informaci&#243;n Microbiol&#243;gica fueron la principal fuente de informaci&#243;n&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">De acuerdo con la legislaci&#243;n espa&#241;ola&#44; no se precisa el consentimiento informado para los datos de vigilancia epidemiol&#243;gica&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En la hoja de notificaci&#243;n se recogieron las siguientes variables&#58; comunidad aut&#243;noma&#44; fecha&#44; edad&#44; sexo&#44; a&#241;o de diagn&#243;stico&#44; categor&#237;a de transmisi&#243;n&#44; pa&#237;s de origen y cifra de linfocitos CD4&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La b&#250;squeda y la eliminaci&#243;n de duplicados se realiz&#243; en las comunidades&#44; y posteriormente los datos se enviaron al Centro Nacional de Epidemiolog&#237;a para su agregaci&#243;n y an&#225;lisis conjunto&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Siguiendo las normas internacionales<a class="elsevierStyleCrossRefs" href="#bib0085"><span class="elsevierStyleSup">17&#44;18</span></a> se defini&#243; como &#171;diagn&#243;stico tard&#237;o&#187; el realizado en una persona con menos de 350 CD4&#47;&#956;l en el momento del diagn&#243;stico&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se realizaron distribuciones de los nuevos diagn&#243;sticos y del diagn&#243;stico tard&#237;o seg&#250;n las variables de persona&#44; lugar y tiempo&#46; Para evaluar la asociaci&#243;n entre variables cualitativas se utiliz&#243; el test de ji al cuadrado y las medianas se compararon con el test de la mediana&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">Para calcular las tasas de nuevos diagn&#243;sticos de VIH se utilizaron como denominadores las Proyecciones de Poblaci&#243;n del Instituto Nacional de Estad&#237;stica con el censo de 2001 &#40;escenario 2&#41;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a>&#59; para la tasa global y las tasas por regi&#243;n de origen y categor&#237;a de transmisi&#243;n el denominador fue la poblaci&#243;n total de las comunidades aut&#243;nomas participantes&#44; exceptuando la tasa de nuevos diagn&#243;sticos en hombres que tienen sexo con hombres &#40;HSH&#41;&#44; cuyo denominador fue el total de poblaci&#243;n masculina de dichas comunidades&#59; para calcular las tasas espec&#237;ficas por edad y sexo se utilizaron las poblaciones correspondientes a cada grupo de edad y sexo&#46; Para evaluar tendencias se ajust&#243; un modelo de Poisson&#46; Los datos se analizaron con el paquete estad&#237;stico IBM SPSS Statistics 18<span class="elsevierStyleSup">&#174;</span> &#40;SPSS Inc&#46;&#44; Chicago&#44; IL&#44; EE&#46;UU&#46;&#41;&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Para verificar si las tendencias observadas se mantienen tras corregir por retraso en la notificaci&#243;n&#44; se realiz&#243; dicha correcci&#243;n siguiendo la metodolog&#237;a utilizada para el Registro de Sida&#46; Sin embargo&#44; los datos se presentan sin corregir porque&#44; al ser muy recientes algunos sistemas de informaci&#243;n sobre nuevos diagn&#243;sticos&#44; es posible que los factores de correcci&#243;n estimados sean poco estables y por ello la correcci&#243;n sea inadecuada por defecto o por exceso&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Nuevos diagn&#243;sticos de VIH en 2009</span><p id="par0080" class="elsevierStylePara elsevierViewall">En el a&#241;o 2009 se notificaron 2&#46;264 nuevos diagn&#243;sticos de VIH&#44; cuyas caracter&#237;sticas se presentan en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Las comunidades aut&#243;nomas que m&#225;s casos notificaron fueron Catalu&#241;a y Madrid &#40;560 y 500 casos&#44; respectivamente&#41;&#44; y las que menos Ceuta y Melilla&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0085" class="elsevierStylePara elsevierViewall">Casi el 80&#37; de las personas diagnosticadas eran hombres&#46; La mediana de edad al diagn&#243;stico fue de 36 a&#241;os &#40;rango intercuart&#237;lico&#58; 29-43&#41;&#44; y significativamente menor en las mujeres que en los hombres &#40;34 frente a 36 a&#241;os&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">M&#225;s de un tercio de las personas nuevamente diagnosticadas eran de origen extranjero&#46; Tras el origen espa&#241;ol&#44; los m&#225;s frecuentes fueron Latinoam&#233;rica&#44; &#193;frica Subsahariana y Europa occidental &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46; Entre las mujeres&#44; m&#225;s del 50&#37; de los nuevos diagn&#243;sticos era en inmigrantes&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">En la mayor&#237;a de los casos &#40;77&#37;&#41; se atribuy&#243; la infecci&#243;n a la transmisi&#243;n sexual&#46; La categor&#237;a de transmisi&#243;n m&#225;s com&#250;n &#40;42&#44;5&#37;&#41; fue la de los hombres que tienen sexo con hombres&#44; seguida de la transmisi&#243;n heterosexual y la parenteral&#46; Por comunidades aut&#243;nomas la distribuci&#243;n es heterog&#233;nea&#44; destacando el porcentaje que alcanza la transmisi&#243;n homosexual y bisexual en Madrid&#44; Canarias&#44; Asturias y Catalu&#241;a&#44; y el alto porcentaje que supone la heterosexual en La Rioja&#44; Arag&#243;n y Navarra &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">Desglosadas las categor&#237;as de transmisi&#243;n por sexo&#44; entre los hombres la transmisi&#243;n homosexual&#47;bisexual supone en 2009 el 53&#44;4&#37; de los nuevos diagn&#243;sticos de VIH y la heterosexual el 23&#37;&#46; Entre las mujeres&#44; la transmisi&#243;n heterosexual representa casi el 80&#37; de los nuevos diagn&#243;sticos&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Al observar la distribuci&#243;n de los casos por categor&#237;a de transmisi&#243;n y regi&#243;n de origen se aprecia que&#44; entre los diagn&#243;sticos en hombres que tienen sexo con hombres&#44; aparte de los espa&#241;oles&#44; ocupan un lugar destacado los latinoamericanos&#44; con un 24&#37;&#46; En la categor&#237;a heterosexual&#44; tanto el origen subsahariano como el latinoamericano tienen un peso importante&#46; Entre los nuevos diagn&#243;sticos en UDVP destacan los inmigrantes de Europa del Este&#44; que representan casi un 10&#37; de los casos&#46; Si se desglosan los nuevos diagn&#243;sticos por lugar de origen y categor&#237;a de transmisi&#243;n&#44; es notoria la gran heterogeneidad que presentan las personas inmigrantes &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a> A y B&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall">En 2009&#44; en casi el 87&#37; de los nuevos diagn&#243;sticos de VIH se dispon&#237;a de informaci&#243;n sobre la cifra de CD4 en la primera determinaci&#243;n realizada tras el diagn&#243;stico&#44; y la mediana de CD4&#47;&#956;l fue de 347 &#40;rango intercuart&#237;lico&#58; 152- 555&#41;&#46; Un 30&#44;4&#37; de los casos presentaban inmunodepresi&#243;n grave &#40;&#60;200 CD4&#41; y un 19&#44;8&#37; ten&#237;an entre 200 y 350 CD4&#47;&#956;l&#46; Por tanto&#44; un 50&#44;2&#37; de los nuevos diagn&#243;sticos fueron tard&#237;os&#44; y en el momento de detectarse la infecci&#243;n eran ya tributarios de tratamiento antirretroviral&#46; El diagn&#243;stico tard&#237;o aumenta con la edad&#44; pasando del 33&#37; en los m&#225;s j&#243;venes al 70&#37; en los mayores de 55 a&#241;os&#44; y fue algo superior en los inmigrantes&#46; Entre los sexos el porcentaje es similar&#44; y por categor&#237;a de transmisi&#243;n las cifras son m&#225;ximas en los hombres heterosexuales&#44; siendo los hombres que tienen sexo con hombres los que presentan menor retraso &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tendencia de los nuevos diagn&#243;sticos de VIH &#40;2004-2009&#41;</span><p id="par0115" class="elsevierStylePara elsevierViewall">El n&#250;mero de casos y las tasas por mill&#243;n de habitantes y a&#241;o para las nueve comunidades aut&#243;nomas que disponen de datos de todo el periodo 2004-2009 se presentan&#44; desglosados por distintas variables&#44; en la <a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#46; Como se menciona en el apartado de m&#233;todos&#44; los datos no est&#225;n corregidos por retraso en la notificaci&#243;n&#44; por lo que en particular la tasa del &#250;ltimo a&#241;o est&#225; bastante subestimada&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0120" class="elsevierStylePara elsevierViewall">Se aprecian diferentes tendencias en los nuevos diagn&#243;sticos seg&#250;n las categor&#237;as de transmisi&#243;n&#44; con un descenso progresivo y estad&#237;sticamente significativo de los UDVP durante el periodo&#44; tanto en cifras absolutas como relativas&#46; En la transmisi&#243;n heterosexual&#44; aunque se evidencia un descenso en el porcentaje de nuevos diagn&#243;sticos por esta causa&#44; las tasas est&#225;n bastante estabilizadas&#44; sobre todo considerando que no se han corregido por retraso en la notificaci&#243;n&#46; Por el contrario&#44; es evidente el aumento estad&#237;sticamente significativo en las tasas en el caso de la transmisi&#243;n entre hombres que tienen sexo con hombres &#40;55&#44;5 por mill&#243;n de poblaci&#243;n masculina en 2004 frente a 81&#44;2 por mill&#243;n en 2008 y 66&#44;1 por mill&#243;n en 2009&#41;&#46; Considerando el peso creciente que la transmisi&#243;n homosexual&#47;bisexual tiene en el conjunto de los datos&#44; el incremento en sus tasas repercute sobre las globales &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0125" class="elsevierStylePara elsevierViewall">El porcentaje de nuevos diagn&#243;sticos de VIH en los inmigrantes aument&#243; desde el 31&#37; en 2004 hasta el 36&#44;3&#37; en 2009&#44; pero el incremento en el n&#250;mero absoluto de casos es poco importante&#46; La proporci&#243;n de latinoamericanos presenta una tendencia ascendente en el periodo&#44; mientras que la de subsaharianos permanece estable &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Analizando la distribuci&#243;n de casos por zona de origen y categor&#237;a de transmisi&#243;n&#44; se aprecia que desde 2005 la transmisi&#243;n entre hombres que tienen sexo con hombres ocupa el primer lugar entre los espa&#241;oles&#44; mientras que en los inmigrantes predomina la heterosexual&#46; Para esta &#250;ltima categor&#237;a&#44; la tendencia es descendente en los hombres y las mujeres espa&#241;oles&#44; pero tiende a la estabilizaci&#243;n en las personas de otros pa&#237;ses &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Si la desagregaci&#243;n por origen y categor&#237;a de transmisi&#243;n se hace por sexo&#44; la transmisi&#243;n entre hombres que tienen sexo con hombres es mayoritaria en los espa&#241;oles y los extranjeros&#44; y presenta una tendencia creciente&#59; entre las mujeres de cualquier origen predomina la transmisi&#243;n heterosexual&#46;</p><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0135" class="elsevierStylePara elsevierViewall">La proporci&#243;n de diagn&#243;sticos tard&#237;os muestra una tendencia descendente&#44; del 56&#37; en 2004 frente al 51&#37; en 2009&#46; Esto es un reflejo de lo que sucede entre los hombres que tienen sexo con hombres&#44; cuya proporci&#243;n de retraso diagn&#243;stico baj&#243; del 51&#37; al 45&#37;&#46;</p></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0140" class="elsevierStylePara elsevierViewall">En este art&#237;culo se presentan por primera vez datos sobre nuevos diagn&#243;sticos de VIH en todas las comunidades aut&#243;nomas excepto cuatro&#44; as&#237; como datos sobre tendencia en nueve comunidades&#46; Los resultados reflejan una situaci&#243;n cambiante en cuanto al modo de transmisi&#243;n y el impacto de los inmigrantes en la epidemia del VIH en Espa&#241;a&#44; y muestran que no hay una sola epidemia sino que coexisten diferentes subepidemias con tendencias heterog&#233;neas&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">En comparaci&#243;n con el pico de incidencia del sida<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#44; las tasas de nuevos diagn&#243;sticos de VIH de los &#250;ltimos a&#241;os se han reducido casi a la mitad&#44; aunque todav&#237;a se sit&#250;an en los valores m&#225;s altos de la Uni&#243;n Europea&#44; junto a las de Francia o B&#233;lgica&#44; pero son menores que las de Reino Unido<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Las cifras halladas tambi&#233;n son mayores que las de otro estudio realizado previamente en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#44; pero el periodo de tiempo era diferente y el &#225;mbito mucho menos amplio&#44; incluyendo en general comunidades aut&#243;nomas menos afectadas por la epidemia del VIH&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">Tradicionalmente&#44; en Espa&#241;a la epidemia del VIH ha mostrado un predominio masculino&#46; En la actualidad este perfil se acent&#250;a&#44; pues la raz&#243;n hombre&#47;mujer ha aumentado respecto a la observada en los casos de sida antes de introducirse el TARGA<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; No obstante&#44; en la transmisi&#243;n heterosexual dicha raz&#243;n se aproxima a la unidad&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">La edad media de los nuevos diagn&#243;sticos de VIH en 2009 fue mayor que la registrada en los casos de sida al inicio de la epidemia&#44; lo que hace pensar que&#44; aunque la incidencia de nuevos diagn&#243;sticos en j&#243;venes es importante&#44; la epidemia se desplaza hacia edades m&#225;s avanzadas&#46; M&#225;s del 10&#37; de las personas diagnosticadas en 2009 superaba los 49 a&#241;os de edad&#44; lo cual indica la necesidad de reforzar la prevenci&#243;n en este grupo de poblaci&#243;n y prever los problemas espec&#237;ficos&#44; asistenciales y otros&#44; que le afectan<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">22</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">Al igual que ya ocurr&#237;a en otros pa&#237;ses de renta alta<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;23</span></a>&#44; actualmente en Espa&#241;a la infecci&#243;n por el VIH es de trasmisi&#243;n mayoritariamente sexual&#44; con predominio de la transmisi&#243;n entre hombres que tienen sexo con hombres&#46; Por ello&#44; sin descuidar otras formas de transmisi&#243;n&#44; es necesario reforzar las medidas de prevenci&#243;n de la transmisi&#243;n sexual del virus&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">La tendencia de los nuevos diagn&#243;sticos de VIH en los UDVP se explica porque el n&#250;mero de &#233;stos ha descendido enormemente en Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a>&#46; No obstante&#44; las personas que a&#250;n se inyectan siguen teniendo las prevalencias de VIH m&#225;s altas del pa&#237;s&#44; y la incidencia de seroconversi&#243;n entre ellas es muy elevada<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Por tanto&#44; considerando el riesgo individual y el principio de equidad&#44; los UDVP siguen siendo prioritarios para la prevenci&#243;n del VIH&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">El incremento de la tasa de nuevas infecciones en los hombres que tienen sexo con hombres es com&#250;n a otros pa&#237;ses europeos<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; Una parte de este aumento puede deberse a la mayor frecuencia de realizaci&#243;n de la prueba del VIH entre ellos&#44; circunstancia ya documentada en otros pa&#237;ses<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a>&#46; En Espa&#241;a&#44; en las cl&#237;nicas de VIH e infecciones de transmisi&#243;n sexual &#40;ITS&#41; ha crecido el n&#250;mero de hombres que tienen sexo con hombres que se realizan la prueba del VIH<a class="elsevierStyleCrossRefs" href="#bib0125"><span class="elsevierStyleSup">25&#44;27</span></a>&#44; y el diagn&#243;stico tard&#237;o entre ellos es menor que en otros grupos<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44; lo que apoyar&#237;a esta interpretaci&#243;n&#46; Sin embargo&#44; en las mismas cl&#237;nicas tambi&#233;n han aumentado las pruebas en los heterosexuales&#44; y no se ha observado un incremento proporcional de nuevos diagn&#243;sticos<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#46; Por lo dem&#225;s&#44; los hombres que tienen sexo con hombres est&#225;n sobrerrepresentados en los pacientes con otras ITS como la s&#237;filis y el linfogranuloma ven&#233;reo&#44; y ha habido brotes de ambas enfermedades en el colectivo&#44; lo cual se&#241;ala que se dan conductas de riesgo para la transmisi&#243;n sexual del VIH<a class="elsevierStyleCrossRefs" href="#bib0145"><span class="elsevierStyleSup">29&#8211;31</span></a>&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Al examinar las tendencias llama la atenci&#243;n que mientras en d&#233;cadas previas los tres modos mayoritarios de transmisi&#243;n evolucionaban de forma similar&#44; ahora ya no es as&#237;&#44; por lo que no es posible hablar de una &#250;nica epidemia de VIH en Espa&#241;a&#44; sino que ser&#237;a m&#225;s preciso referirse a distintas subepidemias con sus propias din&#225;micas que se superponen&#44; moduladas adem&#225;s por el impacto de la inmigraci&#243;n&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">En los &#250;ltimos 15 a&#241;os ha aumentado enormemente el n&#250;mero de inmigrantes en Espa&#241;a&#44; y ello se refleja en la epidemia del VIH&#58; en 2001 tan solo el 7&#37; de los casos de sida eran extranjeros<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a>&#44; mientras que en 2009 ese porcentaje subi&#243; al 31&#37; y casi el 40&#37; de los nuevos diagn&#243;sticos de VIH eran en extranjeros&#46; El impacto de la inmigraci&#243;n es especialmente relevante en la transmisi&#243;n heterosexual&#44; y la evoluci&#243;n de los patrones migratorios influir&#225; sin duda en la tendencia futura de este modo de transmisi&#243;n en el cual los inmigrantes ya son mayor&#237;a&#46; Aunque esto tambi&#233;n ocurre en la Uni&#243;n Europea<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#44; hay matices diferenciadores&#46; En otros pa&#237;ses europeos los inmigrantes infectados son mayoritariamente subsaharianos originarios de pa&#237;ses de alta prevalencia&#59; sin embargo&#44; en Espa&#241;a la inmigraci&#243;n latinoamericana es muy relevante y tiene un impacto importante en la transmisi&#243;n homosexual&#47;bisexual&#44; pues los hombres que tienen sexo con hombres latinos son muy vulnerables al VIH<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a>&#46; Adem&#225;s&#44; en el conjunto de la Uni&#243;n Europea disminuye la proporci&#243;n de inmigrantes mientras que en Espa&#241;a aumenta&#44; aunque en n&#250;meros absolutos el incremento es discreto&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">En cuanto a si los inmigrantes se infectan en su pa&#237;s de origen o aqu&#237;&#44; parece que ocurren ambas cosas&#46; As&#237;&#44; en las cl&#237;nicas de VIH&#47;ITS&#44; la prevalencia del VIH en la primera visita es mayor en los inmigrantes &#40;excepto en los de Europa del Este&#41; que en los espa&#241;oles<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a>&#44; pero en las revisiones se objetivan mayores tasas de seroconversi&#243;n en los inmigrantes latinoamericanos y subsaharianos<a class="elsevierStyleCrossRef" href="#bib0125"><span class="elsevierStyleSup">25</span></a>&#46; Tambi&#233;n se ha referido una alta proporci&#243;n de infecciones recientes en inmigrantes tras su llegada a Espa&#241;a<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a>&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">La magnitud del diagn&#243;stico tard&#237;o es importante&#44; pero las cifras son parecidas a las de los pa&#237;ses similares al nuestro<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a>&#46; El retraso diagn&#243;stico es mucho mayor en los hombres&#44; los inmigrantes latinoamericanos y subsaharianos&#44; y las personas infectadas por v&#237;a parenteral y heterosexual<a class="elsevierStyleCrossRef" href="#bib0140"><span class="elsevierStyleSup">28</span></a>&#44; por lo que es imprescindible aumentar la frecuencia de la prueba del VIH en estos colectivos&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">Este estudio presenta algunas limitaciones&#46; En primer lugar&#44; los resultados no son extrapolables a todo el pa&#237;s&#59; no obstante&#44; el porcentaje de poblaci&#243;n representada es muy alto&#44; y la informaci&#243;n que se aporta resulta imprescindible para orientar las pol&#237;ticas de prevenci&#243;n del VIH de una forma m&#225;s cient&#237;fica&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Al no disponer de identificadores no ha sido posible eliminar duplicados entre comunidades aut&#243;nomas&#59; sin embargo&#44; la mayor&#237;a de los duplicados se producen dentro de la misma comunidad&#44; y al incluir en los c&#225;lculos s&#243;lo residentes de las comunidades aut&#243;nomas participantes no creemos que la sobrestimaci&#243;n de la tasa global sea relevante&#46; Por lo dem&#225;s&#44; la posible sobrestimaci&#243;n podr&#237;a compensarse con la subestimaci&#243;n que pudiera darse en algunas comunidades aut&#243;nomas donde la notificaci&#243;n era voluntaria en 2009&#46;</p><p id="par0205" class="elsevierStylePara elsevierViewall">Para calcular las tasas de incidencia espec&#237;ficas seg&#250;n la categor&#237;a de transmisi&#243;n y el lugar de origen se ha usado como denominador la poblaci&#243;n general&#44; en lugar de las correspondientes poblaciones espec&#237;ficas&#46; Existe alguna estimaci&#243;n del tama&#241;o de las subpoblaciones de UDVP y de hombres que tienen sexo con hombres&#44; y para los inmigrantes podr&#237;a usarse el padr&#243;n&#46; Sin embargo&#44; estas poblaciones tienen limitaciones importantes&#44; por lo que se ha preferido utilizar como denominador la poblaci&#243;n general&#44; ya que con ello se facilita la comparaci&#243;n con los datos de otros pa&#237;ses de la Uni&#243;n Europea&#44; que se presentan de igual forma&#46;</p><p id="par0210" class="elsevierStylePara elsevierViewall">Al no haber realizado una correcci&#243;n por retraso en la notificaci&#243;n&#44; la incidencia registrada&#44; sobre todo la del &#250;ltimo a&#241;o&#44; estar&#237;a subestimada&#59; sin embargo&#44; con esta salvedad&#44; creemos que la tendencia global y la observada en los diferentes grupos de transmisi&#243;n no cambiar&#225;n cuando se complete la notificaci&#243;n&#46; De hecho&#44; se ha corregido por retraso en la notificaci&#243;n aplicando el m&#233;todo utilizado para los casos de sida y&#44; efectivamente&#44; las tendencias no cambian &#40;datos no presentados&#41;&#46;</p><p id="par0215" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en comparaci&#243;n con las d&#233;cadas de 1980 y 1990&#44; este estudio muestra el cambio que se ha producido en la epidemiolog&#237;a del VIH en Espa&#241;a&#46; Se pone de manifiesto tanto la mayor heterogeneidad de los afectados como la mayor complejidad en la evoluci&#243;n de la epidemia&#44; de manera que ya no puede hablarse de una epidemia &#250;nica sino de varias subepidemias que se superponen&#46; Todo ello a&#241;ade dificultad a las tareas de prevenci&#243;n y representa un desaf&#237;o para la vigilancia epidemiol&#243;gica&#44; que deber&#225; adaptarse a esta situaci&#243;n compleja y cambiante&#46;<elsevierMultimedia ident="tb0005"></elsevierMultimedia></p></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Contribuciones de autor&#237;a</span><p id="par0230" class="elsevierStylePara elsevierViewall">M&#46; D&#237;ez ide&#243; el art&#237;culo&#44; planific&#243; el an&#225;lisis&#44; escribi&#243; la primera versi&#243;n del manuscrito y realiz&#243; las revisiones sucesivas hasta llegar a la versi&#243;n final&#46; J&#46; Oliva realiz&#243; la agregaci&#243;n de datos&#44; el control de calidad&#44; la planificaci&#243;n y el an&#225;lisis de la base de datos global&#44; prepar&#243; las tablas y figuras del art&#237;culo&#44; y contribuy&#243; en los sucesivos borradores del manuscrito&#46; F&#46; S&#225;nchez contribuy&#243; en el manejo de los datos y el an&#225;lisis de la base de datos global&#44; y revis&#243; a fondo todos los borradores del manuscrito&#46; Los restantes miembros del Grupo SINIVIH realizaron la recogida&#44; la agregaci&#243;n de los datos y el control de calidad en las bases correspondientes a su comunidad aut&#243;noma&#44; y realizaron revisiones en profundidad de todos los borradores del manuscrito&#46; Todos los autores revisaron y aprobaron la versi&#243;n final&#46;</p></span><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Financiaci&#243;n</span><p id="par0235" class="elsevierStylePara elsevierViewall">Ninguna&#46;</p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflictos de intereses</span><p id="par0240" class="elsevierStylePara elsevierViewall">Ninguno&#46;</p></span></span>"
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              "titulo" => "Nuevos diagn&#243;sticos de VIH en 2009"
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              "identificador" => "sec0025"
              "titulo" => "Tendencia de los nuevos diagn&#243;sticos de VIH &#40;2004-2009&#41;"
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    "fechaRecibido" => "2011-04-01"
    "fechaAceptado" => "2011-07-17"
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            1 => "Transmisi&#243;n sexual del VIH"
            2 => "Tendencias"
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            4 => "Hombres que tienen sexo con hombres"
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            1 => "HIV sexual transmission"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la incidencia de nuevos diagn&#243;sticos de infecci&#243;n por el virus de la inmunodeficiencia humana &#40;VIH&#41; y su tendencia&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Se incluyeron los nuevos diagn&#243;sticos de VIH notificados en 2009 en las 15 comunidades aut&#243;nomas con sistemas de informaci&#243;n &#40;64&#37; de la poblaci&#243;n espa&#241;ola&#41;&#46; Para analizar las tendencias durante 2004-2009 se incluyeron las nueve comunidades con datos en ese periodo&#46; Se obtuvo informaci&#243;n cl&#237;nico-epidemiol&#243;gica de las hojas de notificaci&#243;n de casos y se realizaron distribuciones de nuevos diagn&#243;sticos y diagn&#243;stico tard&#237;o seg&#250;n distintas variables&#46; Para evaluar las tendencias se ajust&#243; un modelo de Poisson&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">En 2009 se notificaron 2&#46;264 nuevos diagn&#243;sticos de VIH&#44; la mayor&#237;a en hombres &#40;80&#37;&#41;&#46; La mediana de edad al diagn&#243;stico fue de 36 a&#241;os &#40;rango intercuart&#237;lico 29-43&#41; y el 37&#44;6&#37; de los casos eran inmigrantes&#44; destacando los latinoamericanos y los subsaharianos&#46; La categor&#237;a de transmisi&#243;n m&#225;s com&#250;n &#40;42&#44;5&#37;&#41; fue la de hombres que tienen sexo con hombres&#44; seguida de la heterosexual &#40;34&#44;5&#37;&#41; y la parenteral &#40;8&#44;1&#37;&#41;&#46; Al diagn&#243;stico&#44; la mediana de CD4&#47;&#956;l era de 347 &#40;rango intercuart&#237;lico&#58; 152-555&#41; y un 50&#44;2&#37; ten&#237;an &#60;350&#46; La tasa media de incidencia de nuevos diagn&#243;sticos entre 2004 y 2009 fue de 91&#44;14 por mill&#243;n de habitantes&#59; se observ&#243; una tendencia creciente de las tasas entre los hombres que tienen sexo con hombres&#44; y decreciente de la transmisi&#243;n parenteral&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La epidemiolog&#237;a del VIH en Espa&#241;a ha cambiado mucho respecto a los a&#241;os 1990&#46; Actualmente predomina la transmisi&#243;n sexual&#44; sobre todo entre los hombres que tienen sexo con hombres&#44; y los inmigrantes son parte importante de la epidemia&#46; En 2004-2009&#44; la tendencia es heterog&#233;nea en las tres categor&#237;as de transmisi&#243;n m&#225;s relevantes&#46;</p>"
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        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To describe the incidence of new HIV diagnoses and its trend in Spain&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">All new HIV diagnoses notified to the case-registries of 15 autonomous regions &#40;64&#37; of the total Spanish population&#41; in 2009 were analyzed&#46; To evaluate trends from 2004 to 2009&#44; data from only nine regions were available&#46; Clinical-epidemiological data were obtained from the notification forms&#46; Distributions of new HIV diagnoses and late diagnoses according to several variables were performed&#46; The Poisson distribution was used to evaluate trends&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">In 2009&#44; 2264 new HIV diagnoses were notified&#44; mostly in men &#40;80&#37;&#41;&#46; The median age at diagnosis was 36 years &#40;interquartile range 29-43&#41; and 37&#46;6&#37; of affected individuals were immigrants&#44; mostly from Latin-America and sub-Saharan Africa&#46; The most common transmission category &#40;42&#46;5&#37;&#41; was men who have sex with men &#40;MSM&#41; followed by the heterosexual and parenteral modes of transmission &#40;34&#46;5&#37; and 8&#46;1&#37;&#44; respectively&#41;&#46; The median CD4 count at diagnosis was 347 &#40;interquartile range&#58; 152-555&#41;&#44; and CD4 count was &#60;350 in 50&#46;2&#37; of patients&#46; From 2004 to 2009&#44; the mean incidence rate of new HIV diagnoses was 91&#46;14 per million inhabitants&#59; an increasing trend for rates in MSM&#44; as well as a decreasing trend for the parenteral mode of transmission&#44; were observed&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">In Spain&#44; the epidemiology of HIV infection has changed since the mid-1990s&#46; Currently&#44; the most frequent transmission category is sexual transmission&#44; particularly among MSM&#44; and immigrants are an important part of the epidemic&#46; Heterogeneous trends for the three main transmission categories were observed from 2004 to 2009&#46;</p>"
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                "apendice" => "<p id="par0250" class="elsevierStylePara elsevierViewall">Javier Cereijo &#40;Servizo de Control de Enfermidades Transmisibles&#44; Direcci&#243;n Xeral de Innovaci&#243;n e Xesti&#243;n da Sa&#250;de P&#250;blica&#44; Xunta de Galicia&#41;&#44; Arantxa Arrillaga &#40;Plan de Prevenci&#243;n y Control del Sida del Pa&#237;s Vasco&#44; San Sebasti&#225;n&#41;&#44; Antonio Nicolau &#40;Servicio de Epidemiolog&#237;a&#44; Direcci&#243;n General de Salud P&#250;blica&#44; Consejer&#237;a de Salud y Consumo del Gobierno Balear&#44; Palma de Mallorca&#41;&#44; Ana Fern&#225;ndez &#40;Servicio de Vigilancia y Alertas Epidemiol&#243;gicas&#44; Direcci&#243;n General de Salud P&#250;blica y Participaci&#243;n&#44; Consejer&#237;a de Salud y Servicios Sanitarios del Principado de Asturias&#44; Oviedo&#41;&#44; Mara &#193;lvarez &#40;Subdirecci&#243;n de Epidemiolog&#237;a&#44; Servicio Extreme&#241;o de Salud&#44; Junta de Extremadura&#44; M&#233;rida&#41;&#44; Jes&#250;s Castilla &#40;Instituto de Salud P&#250;blica de Navarra&#44; Pamplona&#41;&#44; Carmen Malo &#40;Direcci&#243;n General de Salud P&#250;blica&#44; Gobierno de Arag&#243;n&#44; Zaragoza&#41;&#44; Eva Mart&#237;nez &#40;Servicio de Epidemiolog&#237;a y Prevenci&#243;n Sanitaria&#44; Consejer&#237;a de Salud del Gobierno de La Rioja&#44; Logro&#241;o&#41;&#44; Henar Marcos &#40;Servicio de Vigilancia Epidemiol&#243;gica y Enfermedades Transmisibles&#44; Direcci&#243;n General de Salud P&#250;blica e Investigaci&#243;n&#44; Desarrollo e Innovaci&#243;n&#44; Consejer&#237;a de Sanidad&#44; Junta de Castilla y Le&#243;n&#44; Valladolid&#41;&#44; Luis Viloria &#40;Secci&#243;n de Vigilancia Epidemiol&#243;gica&#44; Consejer&#237;a de Sanidad&#44; Gobierno de Cantabria&#44; Santander&#41;&#44; Irene L&#243;pez &#40;Servicio de Epidemiolog&#237;a&#44; Consejer&#237;a de Sanidad y Consumo de la Ciudad Aut&#243;noma de Ceuta&#41; y Daniel Castrillejo &#40;Servicio de Epidemiolog&#237;a&#44; Direcci&#243;n General de Sanidad y Consumo&#44; Consejer&#237;a de Bienestar Social y Sanidad de la Ciudad Aut&#243;noma de Melilla&#41;&#46;</p>"
                "etiqueta" => "A&#46;1"
                "titulo" => "Restantes miembros del Grupo SINIVIH &#40;Sistema de Informaci&#243;n sobre Nuevos Diagn&#243;sticos de VIH&#41;&#58;"
                "identificador" => "sec0065"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Distribuci&#243;n de nuevos diagn&#243;sticos de VIH por origen seg&#250;n categor&#237;a de transmisi&#243;n &#40;Espa&#241;a&#44; 2009&#41;&#46; B&#41; Distribuci&#243;n de nuevos diagn&#243;sticos de VIH por categor&#237;a de transmisi&#243;n seg&#250;n origen &#40;Espa&#241;a&#44; 2009&#41;&#46; &#40;Espa&#241;a&#58; Arag&#243;n&#44; Asturias&#44; Baleares&#44; Canarias&#44; Cantabria&#44; Castilla y Le&#243;n&#44; Catalu&#241;a&#44; Ceuta&#44; Extremadura&#44; Galicia&#44; La Rioja&#44; Madrid&#44; Melilla&#44; Navarra y Pa&#237;s Vasco&#46;&#41; UDVP&#58; usuarios de drogas por v&#237;a parenteral&#59; HSH&#58; hombres que tienen sexo con hombres&#59; NC&#58; no consta&#59; hetero&#58; heterosexual&#46;</p>"
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          "es" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Tasas de nuevos diagn&#243;sticos de VIH por mill&#243;n de habitantes&#44; seg&#250;n a&#241;o de diagn&#243;stico y categor&#237;a de transmisi&#243;n&#46; Datos sin corregir por retraso en la notificaci&#243;n &#40;Espa&#241;a&#44; 2004-2009&#41;&#46; &#40;Espa&#241;a&#58; Arag&#243;n&#44; Asturias&#44; Baleares&#44; Canarias&#44; Cantabria&#44; Castilla y Le&#243;n&#44; Catalu&#241;a&#44; Ceuta&#44; Extremadura&#44; Galicia&#44; La Rioja&#44; Madrid&#44; Melilla&#44; Navarra y Pa&#237;s Vasco&#46;&#41; UDVP&#58; usuarios de drogas por v&#237;a parenteral&#59; hetero&#58; heterosexual&#59; HSH&#58; hombres que tienen sexo con hombres&#46;</p>"
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        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
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          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Nuevos diagn&#243;sticos de VIH por a&#241;o y categor&#237;a de transmisi&#243;n&#46; Datos no corregidos por retraso en la notificaci&#243;n &#40;Espa&#241;a&#44; 2004-2009&#41;&#46; &#40;Espa&#241;a&#58; Baleares&#44; Canarias&#44; Catalu&#241;a&#44; Ceuta&#44; Extremadura&#44; Galicia&#44; La Rioja&#44; Navarra y Pa&#237;s Vasco&#46;&#41; UDVP&#58; usuarios de drogas por v&#237;a parenteral&#59; HSH&#58; hombres que tienen sexo con hombres&#46;</p>"
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          "leyenda" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">VIH&#58; virus de la inmunodeficiencia humana&#59; HSH&#58; hombres que tienen sexo con hombres&#59; UDVP&#58; usuarios de drogas por v&#237;a parenteral&#59; NC&#58; no consta&#46;</p>"
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                  \t\t\t\t" style="border-bottom: 2px solid black">Catalu&#241;a&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">Extremadura&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">Galicia&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">Madrid&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">Navarra&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">Pa&#237;s Vasco&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">La Rioja&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">Ceuta&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">Melilla&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">Total&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
                  \t\t\t\t"><span class="elsevierStyleItalic">N &#40;&#37; del total&#41;</span>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">108 &#40;4&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98 &#40;4&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">150 &#40;6&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">180 &#40;8&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">34 &#40;1&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">140 &#40;6&#44;2&#41;&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">560 &#40;24&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">30 &#40;1&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">203 &#40;9&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">500 &#40;22&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;1&#44;4&#41;&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">207 &#40;9&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t">21 &#40;0&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2 &#40;0&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&#46;264 &#40;100&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="17" 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" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="17" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Sexo&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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"><span class="elsevierStyleHsp" style=""></span>Mujer&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">43 &#40;39&#46;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">15 &#40;15&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">33 &#40;22&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">30 &#40;16&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;8&#44;8&#41;&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">24 &#40;17&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">118 &#40;21&#44;1&#41;&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">6 &#40;20&#44;0&#41;&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">47 &#40;23&#44;2&#41;&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">73 &#40;14&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10 &#40;32&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">50 &#40;24&#44;2&#41;&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">10 &#40;47&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">2 &#40;100&#41;&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">464 &#40;20&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombre&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">65 &#40;60&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">83 &#40;84&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">117 &#40;78&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">150 &#40;83&#44;3&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">31 &#40;91&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">116&#40;82&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">442 &#40;78&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">24 &#40;80&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">156 &#40;76&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">427 &#40;85&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">21 &#40;67&#44;7&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">157 &#40;75&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">11 &#40;52&#44;4&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">0 &#40;0&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;800 &#40;79&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="17" 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
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " colspan="17" align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleItalic">Grupo de edad&#44; n &#40;&#37;&#41;</span><a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a></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
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>0-19 a&#241;os&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">6 &#40;5&#44;6&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;5&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">3 &#40;2&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">5 &#40;2&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Mujeres heterosexual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Hombres heterosexual&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Desconocido&#47;NC&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleItalic">Zona de origen</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Espa&#241;a&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Europa Occidental&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Europa del Este&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Latinoam&#233;rica&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;frica Subsahariana&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>&#193;frica del Norte&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">28 &#40;84&#44;8&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Otros&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">16 &#40;84&#44;2&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>Total&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">1968 &#40;86&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">599&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">30&#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="char" valign="\n
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                  \t\t\t\t">988&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">50&#44;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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            0 => array:3 [
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              "nota" => "<p class="elsevierStyleNotepara">Arag&#243;n&#44; Asturias&#44; Baleares&#44; Canarias&#44; Cantabria&#44; Castilla y Le&#243;n&#44; Catalu&#241;a&#44; Extremadura&#44; Galicia&#44; La Rioja&#44; Madrid&#44; Navarra&#44; Pa&#237;s Vasco&#44; Ceuta y Melilla&#46;</p>"
            ]
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        "descripcion" => array:1 [
          "es" => "<p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">Enfermedad avanzada y retraso diagn&#243;stico en los nuevos diagn&#243;sticos de VIH &#40;Espa&#241;a<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&#44; 2009&#41;</p>"
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        "tipo" => "MULTIMEDIATABLA"
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        "tabla" => array:3 [
          "leyenda" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">VIH&#58; virus de la inmunodeficiencia humana&#59; HSH&#58; hombres que tienen sexo con hombres&#59; UDVP&#58; usuarios de drogas por v&#237;a parenteral&#59; NC&#58; no consta&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&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  " colspan="14" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">A&#241;o de diagn&#243;stico del VIH</td></tr><tr title="table-row"><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">Caracter&#237;sticas&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  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2004</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2005</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2006</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2007</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2008</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">2009</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="2" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&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\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">Tasa&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">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\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">Tasa&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">n &#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">Tasa&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\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">Tasa&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\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">Tasa&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
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                  \t\t\t\t" style="border-bottom: 2px solid black">n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Tasa&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Tasa&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
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                  \t\t\t\t  " colspan="15" align="left" valign="\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>Mujer&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">380 &#40;25&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="char" valign="\n
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                  \t\t\t\t">45&#44;74&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">347 &#40;23&#44;9&#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">41&#44;28&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">357 &#40;22&#44;5&#41;&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">42&#44;02&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">340 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">39&#44;71&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">362 &#40;21&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">42&#44;07&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">304 &#40;22&#44;0&#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">2&#46;090 &#40;22&#44;8&#41;&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="elsevierStyleHsp" style=""></span>Hombre&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">1&#46;141 &#40;75&#44;0&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">142&#44;06&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;105 &#40;76&#44;1&#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">135&#44;80&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;234 &#40;77&#44;5&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;216 &#40;78&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">146&#44;42&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&#46;292 &#40;78&#44;1&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">142&#44;89&nbsp;\t\t\t\t\t\t\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"><span class="elsevierStyleItalic">Edad</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>0-19 a&#241;os&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">29 &#40;1&#44;9&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">9&#44;28&nbsp;\t\t\t\t\t\t\n
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