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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or persistent HIV. 1 Without treatment, this second period of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are no or few symptoms at first, close to the end of the stage many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months. Std Test closest to Grove Hill, Alabama. Grove Hill, AL Std Test. 2

Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a tiny proportion (about 5%) retain high levels of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These people are classified as HIV controllers or long-term nonprogressors (LTNP). 31 Another group consists of individuals who maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent approximately 1 in 300 persons that are infected. Grove Hill, 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 incidence of specific diseases in association with an HIV disease. Std Test near me Grove Hill Alabama, United States. 26 In the absence of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alarm to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have a higher danger 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first indication of AIDS in 3 to 4% and is the cause of death of nearly 16% of people with AIDS. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and also the white portion 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 person. 11 The bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this specific public accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of bisexual and gay guys have HIV. 49 50 Std test nearby Grove Hill.

With regard to unprotected heterosexual contacts, approximations of the danger of HIV transmission per sexual act appear to be four to ten times higher in low income countries than in high income states. 51 In low income countries, 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 estimates 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 danger 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 danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex was described as "almost nil"; 54 however, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings involving prostitution in low income countries, risk of female-to-male transmission was estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The 2nd most common way of HIV transmission is via blood and blood products. 11 Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical injections with unsterilized equipment. The danger from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test nearby AL United States. 63 The risk of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per act and the risk following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in some places more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed countries the danger of acquiring 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 UK 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 appropriately screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test nearby AL, United States. 11 68 Although rare because of screening, it's possible to get HIV from organ and tissue transplantation 69

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HIV could be transmitted from mother to child during pregnancy, during delivery, or through breast milk resulting in infection in the infant. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the absence of treatment, the danger of transmission before or during birth is around 20% and in those who additionally breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment involves the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decline the danger of transmission in people who do breastfeed. 76 Many of these measures are however not obtainable in the developing world. 75 If food is contaminated by blood during pre- it may pose a danger of transmission. 71

HIV is an associate 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 illnesses with a long incubation period 81 Lentiviruses are transmitted as single-stranded, positive- sense , enveloped RNA viruses Upon entry into the target cell, the viral RNA genome is converted (reverse 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 then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once incorporated, the virus may become latent, allowing the virus and its own host cell to avoid detection by the immune system. 83 Alternatively, the virus could be transcribed, creating viral proteins that are packaged and released from the cell as new virus particles that start the replication cycle anew and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it applies crossed spreading mechanics. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std Test closest to Grove Hill Alabama. 86 87 The hybrid spreading mechanisms of HIV contribute to the on-going replication of the virus against antiretroviral therapies. 85 88

There's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood, following the virus enters the body. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable fall in the number of circulating CD4 T cells. The acute viremia is almost always related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell response is believed to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been associated with a better prognosis and also slower disease progression, though it will not remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are crucial to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the long-term and acute stages. 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 period, the consequences 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for decades after someone is infected, the bulk of CD4 T cell loss happens during the first weeks of infection, especially in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body. 95 The reason for 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 obtain access to the cells, whereas merely a tiny 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 seeks out and destroys CCR5 expressing CD4 T cells during acute disease. 98 A vigorous immune response eventually controls the disease and initiates the latent period. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the long-term period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of the immune response as well as several HIV gene products to HIV replication that is continuing. Additionally it is linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier resulting from the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Grove Hill AL std test. HIV/AIDS is diagnosed via lab testing and then staged based on the presence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Additionally, testing is recommended for those at high risk, which includes anyone. 27 In many regions of the planet, a third of HIV carriers simply discover they are infected at an advanced period of the disorder when AIDS or acute immunodeficiency has become apparent. Std Test in Grove Hill, AL. 27

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Antibody evaluations in children younger than 18months are commonly incorrect due to the ongoing existence of maternal antibodies 102 Hence HIV infection 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 reliable PCR testing and a lot of places simply wait the child is old enough for antibody testing that is exact or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Grove Hill std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were analyzed 103 which signified a substantial increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related ailment for surveillance purposes: the WHO disorder staging system for HIV infection and disease , 24 and 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 does not need laboratory evaluations, it's satisfied to the resource-controlled conditions encountered in developing countries, where it may also be used to help guide clinical management. Despite their differences, the two systems enable comparison for statistical purposes. 2 24 104

Consistent condom use reduces the risk 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's some evidence to imply that female condoms may provide an equivalent level of protection. Std test nearby Grove Hill. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission because of its tendency to cause rectal and vaginal irritation. 110

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

Plans encouraging sexual abstinence do not appear to change subsequent HIV danger. 120 Signs of any gain from peer education is equally poor. 121 Complete sexual education provided at school may fall high risk behaviour. 122 A substantial minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearest AL United States. 123 Voluntary counseling and testing people for HIV doesn't change dangerous behavior in those who test negative but does raise condom use in those who test positive. 124 It isn't known whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is an extremely productive method to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Grove Hill 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 drugs tenofovir , with or without emtricitabine , is successful in a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be effective in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially therapy is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States recommends antiretrovirals in individuals of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it's advised that it's continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially advocated after four weeks and once degrees drop below 50copies/mL tests every three to six months are usually sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of individuals during the first year. 27

Advantages of treatment include a decreased danger of death and also a decreased risk of progression to AIDS. Std test nearest Grove Hill Alabama. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a reduced risk of transmission of the disease to sexual partners and a reduction in mom-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Reasons for non-adherence include poor access to medical care, 149 inadequate 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 people who needed them were taking them in the speed of adherence and low and middle income countries as of 2010 143 is similar in low-income and high-income countries. 153

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