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The initial symptoms are followed by a period called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second phase of the natural history of HIV disease can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are no or few symptoms in the beginning, near the end of this stage a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test nearby Lynn, Alabama. Lynn 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 small percentage (about 5%) keep high rates of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These people are classified as HIV accountants or long-term nonprogressors (LTNP). 31 Another group consists of individuals who keep a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 contaminated individuals. Lynn, 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 disorders in association with an HIV infection. Std test near me Lynn Alabama United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common first conditions that alert to the existence of AIDS are pneumocystis pneumonia (40%), cachexia in the type 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 people with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 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 often in those with AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more common in those with HIV. 36

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The most frequent 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 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 public 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 men have HIV. 49 50 Std Test closest to Lynn.

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

The second most frequent 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 threat 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 me AL, United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in a few regions more than 80% of individuals 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 extremely low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for instance, in the united kingdom the hazard 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's 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 will be likely to acquire 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 baby. 73 74 This is the third most common manner in which HIV is transmitted globally. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in individuals who additionally breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment involves the mom avoiding breastfeeding, taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed. 76 Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it may 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses using a 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported together with the viral genome in the virus particle. The resulting viral DNA is subsequently imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once integrated, the virus may become latent, allowing the virus and its particular 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 routes: cell free spread and cell-to-cell spread, i.e. it applies crossed propagating mechanisms. 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 can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test closest to Lynn, Alabama. 86 87 The hybrid distributing mechanics of HIV contribute to the virus's ongoing replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, leading to plenty of virus in the peripheral blood, after the virus enters the body. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a noticeable fall in the amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is regarded as significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been associated with slower disease progression along with a better prognosis, though it will not remove the virus. 92

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Ultimately, 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 diseases or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and long-term phases. 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 factor. During the chronic stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells seem to account for the slow decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS don't appear for a long time after someone is infected, the bulk of CD4 T cell loss happens during the first weeks of disease, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body. 95 The reason behind the preferential loss of mucosal CD4 T cells is that nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas merely a small fraction of CD4 T cells in the bloodstream do thus. 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 disease and seeks out. The infection is eventually controlled by 98 A vigorous immune response and initiates the latent period. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the chronic phase. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the action of several HIV gene products and also the immune response to ongoing HIV replication. Additionally it is linked to the breakdown 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

Lynn AL Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Additionally, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many regions of the world, a third of HIV carriers only find when severe immunodeficiency or AIDS is now evident they are infected at an advanced stage of the disease. Std test nearest Lynn, AL. 27

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Antibody tests in kids younger than 18months are commonly inaccurate due to the continued presence 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 dependable PCR testing and several areas simply wait the kid is old enough for precise antibody testing or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Lynn std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were tested 103 which represented a substantial increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 as well as the CDC classification system for HIV infection 104 The CDC 's classification system is more often adopted in developed countries. Since the WHO 's staging system doesn't require laboratory tests, it is suited to the resource-restricted states seen in developing countries, where it may also be used to help guide clinical management. Despite their differences, the two systems enable comparison for statistical functions. 2 24 104

Consistent condom use reduces the risk of HIV transmission by about 80% over the long term. 106 When condoms are used consistently by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to suggest that female condoms may offer an equal level of protection. Std test in Lynn. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by approximately 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 vaginal and rectal 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in areas with a high rates of HIV in 2007. 112 Nevertheless, whether it protects against male to female transmission is contested, 113 114 and whether it's of benefit in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does that it be discussed as an option with men who have sex with men and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behaviour, thus negating its prophylactic effects. 119

Plans encouraging sexual abstinence do not seem to impact subsequent HIV risk. 120 Signs of any gain from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A considerable minority of young people proceeds to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std test near AL, United States. 123 Voluntary counseling and testing people for HIV doesn't influence hazardous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It is not known whether treating other sexually transmitted infections is effective in preventing HIV. 57

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

Current HAART choices are mixes (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially treatment is usually 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 Combinations of agents which include protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in people 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's advised that it is continued without breaks or "vacations". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Amounts to find out if treatment is effective are initially urged after four weeks and once levels fall below 50copies/mL checks every three to six months are generally adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of people during the first year. 27

Advantages of treatment contain a reduced risk of progression to AIDS as well as a decreased danger of death. Std test closest to Lynn, Alabama. Physical and mental health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a reduced danger of transmission of the disease to sexual partners and a decrease in mom-to-child transmission. The effectiveness of treatment depends to a big 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 intricacy 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 medications, 152 47% of people who desired them were taking them in low and middle income countries as of 2010 143 and also the rate of adherence is comparable in low-income and high-income countries. 153

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