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The initial symptoms are followed by a stage called long-term HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second period of the natural history of HIV infection can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are no or few symptoms initially, near the end of this period lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the groin) for over three to six months. Std Test near me Brooklyn Alabama. Brooklyn AL std test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a little proportion (about 5%) keep high rates of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV controllers or long term nonprogressors (LTNP). 31 Another group consists of people who maintain a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 contaminated individuals. Brooklyn Alabama Std Test. 32

Acquired immunodeficiency syndrome (AIDS) is defined in terms of either a CD4 T cell count below 200 cells per L or the occurrence of specific disorders in association with an HIV disease. Std Test near Brooklyn Alabama United States. 26 In the lack of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the kind of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

People with AIDS have a higher risk of developing various viral-induced cancers, including Kaposi's sarcoma , Burkitt's lymphoma , primary central nervous system lymphoma , and cervical cancer 27 Kaposi's sarcoma is the most typical cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids and also the white part of the eye) is also more common in those with HIV. 36

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The most common mode of transmission of HIV is through sexual contact with an infected individual. 11 The majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, with this people accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive, 49 About 15% of gay and bisexual guys have HIV. 49 50 Std test near Brooklyn.

With respect to unprotected heterosexual contacts, estimates of the danger of HIV transmission per sexual act seem to be four to ten times higher in low-income countries than in high-income countries. 51 In low income nations, the risk of female to male transmission is estimated as 0.38% per action, and of male to female transmission as 0.30% per action; the equivalent approximations for high income nations are 0.04% per action for female to male transmission, and 0.08% per action for male to female transmission. 51 The risk of transmission from anal intercourse is particularly high, estimated as 1.4-1.7% per act in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The risk from receiving oral sex was described as "almost nil"; 54 nonetheless, a couple instances have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings involving prostitution in low income countries, risk of female-to-male transmission was estimated as 2.4% per act and male-to-female transmission as 0.05% per act. 51

The second most common way of HIV transmission is via blood and blood products. 11 Blood-borne transmission can be through needle-sharing needle stick injury, during intravenous drug use, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment. The danger from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test near AL United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed countries the risk of getting HIV from a blood transfusion is very low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for example, in the united kingdom the risk is reported at one in five million 65 and in the United States it was one in 1.5 million in 2008. 66 In low income countries, only half of transfusions may be suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std test in AL, United States. 11 68 Although rare because of screening, it's likely to acquire HIV from tissue and organ transplantation 69

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HIV may be transmitted from mother to child during pregnancy, during delivery, or through breast milk resulting in infection in the baby. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in individuals who also breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the danger of mother-to-child infection could be reduced to about 1%. 73 Preventive treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decline the risk of transmission in people who do breastfeed. Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- it might present a threat of transmission. 71

HIV is a part of the genus Lentivirus , 79 part of the family Retroviridae 80 Lentiviruses share many morphological and biological features. Many species of mammals are infected by lentiviruses, which are characteristically accountable for long-duration sicknesses using a very long incubation period 81 Lentiviruses are transmitted as single-stranded, positive- sense , enveloped RNA viruses Upon entrance into the target cell, the viral RNA genome is converted (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that's transported together with the viral genome in the virus particle. The resultant viral DNA is subsequently imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once integrated, the virus may become latent, allowing its own host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, generating new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that begin the replication cycle anew. 84

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HIV is now understood to spread between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it uses crossed propagating mechanics. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid after which infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test near Brooklyn Alabama. 86 87 The hybrid spreading mechanisms of HIV contribute to the virus's continuing replication against antiretroviral treatments. 85 88

After the virus enters the body there is a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable drop in the amount of circulating CD4 T cells. The acute viremia is almost invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell reaction is thought to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it will not eliminate the virus a good CD8 T cell response has been linked to slower disease progression as well as a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are critical to the immune response and without them, the body cannot fight diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and long-term periods. 93 During the acute phase, HIV-induced cell lysis and killing of infected cells by cytotoxic T cells accounts for CD4 T cell depletion, although apoptosis might also be a variable. During the chronic phase, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for a long time after a person is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors most of the lymphocytes found in the body, particularly during the first weeks of illness. 95 The reason behind the preferential loss of mucosal CD4 T cells is that most mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas only a little fraction of CD4 T cells in the bloodstream do so. 96 A specific genetic change that alters the CCR5 protein when present in both chromosomes very effectively prevents HIV 1 infection. 97

HIV destroys CCR5 expressing CD4 T cells during acute infection and seeks out. 98 A vigorous immune response controls the disease and starts the clinically latent period. CD4 T cells in mucosal tissues remain particularly changed. 98 Constant HIV replication causes a state of generalized immune activation lasting throughout the chronic stage. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products and the immune response to HIV replication that is continuing. Additionally it is linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Brooklyn, AL Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the presence of certain signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone. 27 In many regions of the world, a third of HIV carriers only discover when acute immunodeficiency or AIDS has become apparent they are infected at an advanced phase of the disease. Std Test near me Brooklyn, AL. 27

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Antibody evaluations in kids younger than 18months are usually inaccurate due to the continuing presence of maternal antibodies 102 Consequently HIV disease can only be diagnosed by PCR testing for HIV RNA or DNA, or via testing for the p24 antigen. 24 Much of the world lacks access to trusted PCR testing and many areas simply wait until either symptoms grow or the child is old enough for antibody testing that is accurate. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Brooklyn std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were tested 103 which represented a considerable increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 along with the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently adopted in developed countries. Since the WHO 's staging system doesn't need laboratory evaluations, it is suited to the resource-restricted conditions seen in developing countries, where it can be utilized to help direct clinical management. Despite their differences, the two systems permit comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used consistently by a couple in which one individual is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may provide an equal degree of protection. Std Test near Brooklyn. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission because of its propensity to cause rectal and vaginal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". 111 Due to these studies, both UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female to male HIV transmission in places using a high rates of HIV in 2007. 112 Yet, whether it shields against male to female transmission is contested, 113 114 and whether it's of benefit in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, nevertheless, does advocate for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, thus negating its preventative effects. 119

Plans supporting sexual abstinence do not appear to influence subsequent HIV risk. 120 Signs of any advantage from peer education is equally poor. 121 Complete sexual education provided at school may decrease high risk behaviour. 122 A sizeable minority of young people continues to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test in AL, United States. 123 Voluntary counselling and testing people for HIV doesn't influence dangerous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It is not understood whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test in Brooklyn Alabama United States. 125 TASP is related to a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir , with or without emtricitabine , is successful in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be successful in intravenous drug users with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially treatment is usually a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in individuals of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is begun it is recommended that it is continued without breaks or "holidays". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desired outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is effective are initially advocated after four weeks and once amounts drop below 50copies/mL checks every three to six months are generally adequate. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is effective in more than 95% of individuals during the first year. 27

Advantages of treatment include a reduced danger of death and a reduced risk of progression to AIDS. Std test nearby Brooklyn, Alabama. Mental and physical health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a decreased risk of transmission to sexual partners of the disease and also a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on compliance. 27 Rationales for non-adherence include poor access to medical care, 149 insufficient social supports, mental illness and drug abuse 150 The complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 though price is an important problem with some drugs, 152 47% of those who wanted them were taking them in middle and low income countries as of 2010 143 and the speed of adherence is similar in low income and high income countries. 153

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