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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or long-term 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 commonly there are few or no symptoms in the beginning, close to the end of the phase lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test nearby Pinson Alabama. Pinson 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 tiny proportion (about 5%) retain elevated amounts 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 those who keep a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 individuals that are contaminated. Pinson, 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 in Pinson Alabama, United States. 26 In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common first conditions that alarm to the existence 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 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 who have AIDS and is the initial hint of AIDS in 3 to 4%. 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 part of the eye) is also more prevalent 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 worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, with this population 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 homosexual and bisexual men have HIV. 49 50 Std test near me Pinson.

With regard to unprotected heterosexual contacts, approximations 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 countries, the threat 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 nations are 0.04% per act for female to male transmission, and 0.08% per act for male to female transmission. 51 The risk 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 danger of transmission from oral sex is relatively low, it is still present. 53 The danger from receiving oral sex has been described as "nearly nil"; 54 yet, 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 has been estimated as 2.4% per action and male-to-female transmission as 0.05% per act. 51

The next most frequent mode 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 infected 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 action, with an average of 0.8%. Std test near me AL, United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the threat following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the danger 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 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 regions 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 due to screening, it's possible to acquire HIV from organ and tissue transplantation 69

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HIV can 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 people who additionally breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the danger of mother-to-child infection can 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 the mother or the baby decline the risk of transmission in people who do breastfeed. Many of these measures are yet not available in 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 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 consequent viral DNA is then 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, enabling its own host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus could be transcribed, producing viral proteins which are packaged and released from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it applies crossed spreading 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 may also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test nearby Pinson, Alabama. 86 87 The hybrid spreading mechanisms of HIV contribute to the virus's continuing replication against antiretroviral therapies. 85 88

There is a period of rapid viral replication, resulting in 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 number of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell response is considered to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was great was associated with slower disease progression along with a better prognosis, though it will not get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are essential to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 factor. 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

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for a long time after someone is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body, particularly during the very first weeks of disease. 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 obtain access to the cells, whereas just a small 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 starts the latent stage and eventually controls the disease. CD4 T cells in mucosal tissues remain particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the long-term stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of pro inflammatory 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 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

Pinson AL Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence of particular signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Furthermore, testing is recommended for those at high risk, which includes anyone. 27 In many sections of the planet, a third of HIV carriers simply discover they are infected at an advanced phase of the disease when AIDS or severe immunodeficiency is now apparent. Std Test near Pinson, AL. 27

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Antibody evaluations in kids younger than 18months are usually erroneous due to the ongoing presence of maternal antibodies 102 So 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 dependable PCR testing and many places just wait the child is old enough for accurate antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Pinson Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were examined 103 which represented a significant increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance purposes: 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 frequently adopted in developed nations. Since the WHO 's staging system doesn't need lab tests, it is satisfied to the resource-controlled states seen in developing countries, where it can also be utilized 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 by a couple in which one person is infected, the speed of HIV infection is less than 1% per year. 107 There's some evidence to suggest that female condoms may provide an equal degree of protection. Std test closest to Pinson. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission due to its propensity 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 advocated male circumcision as a method of preventing female to male HIV transmission in 2007 in regions with a high rates of HIV. 112 Yet, whether it protects against male-to-female transmission is questioned, 113 114 and whether it is of advantage in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, 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 worry that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behavior, thereby negating its preventive effects. 119

Programs supporting sexual abstinence don't seem to change subsequent HIV risk. 120 Evidence of any advantage from peer instruction is equally poor. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std test near AL United States. 123 Voluntary counselling and testing individuals for HIV doesn't affect high-risk behavior in individuals who test negative but does raise condom use in those who test positive. 124 It is not 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 a very effective method to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test nearest Pinson Alabama United States. 125 TASP is associated with 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 a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It can also be successful in intravenous drug users using a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three medications 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 analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Mixtures of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States 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 started it is advised that it's continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially recommended after four weeks and once amounts fall below 50copies/mL checks every three to six months are usually 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 people during the very first year. 27

Advantages of treatment include a reduced risk of departure and also a reduced risk of progression to AIDS. Std test nearest Pinson 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 Added advantages include a reduced risk of transmission of the disease to sexual partners and a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 27 Reasons 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 medicines, 152 47% of those who desired they were being taken by them in the speed of adherence and also middle and low income countries as of 2010 143 is similar in low-income and high income countries. 153

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