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The first symptoms are followed by a stage called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second period of the natural history of HIV infection can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms initially, close to the end of this stage a lot of people experience gastrointestinal problems, weight loss, fever 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 nearby Thomasville, Alabama. Thomasville 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 people are classified as HIV controllers 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 persons. Thomasville, 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 infection. Std test nearest Thomasville Alabama, United States. 26 In the lack of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alarm to the presence 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, which is the first sign of AIDS in 3 to 4% and is the cause of death of nearly 16% of individuals with AIDS. 35 Both these cancers are related to 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 as well as the white part of the eye) is also more prevalent 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 worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals 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 particular population 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 Thomasville.

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 nations. 51 In low income nations, the danger of female-to-male transmission is estimated as 0.38% per act, and of male to female transmission as 0.30% per action; the equivalent estimates for high-income states 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 act in both heterosexual and homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The danger from getting oral sex has been described as "virtually nil"; 54 nevertheless, a few cases are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings including 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 next most common mode 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 infected blood or blood product, or medical shots with unsterilized equipment. The threat 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 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 action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in certain places 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 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 instance, in the UK the danger 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 areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std test near me AL, United States. 11 68 Although rare due to screening, it's likely to acquire HIV from tissue and organ transplantation 69

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HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted globally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in people who also 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 may be reduced to about 1%. 73 Preventative treatment includes the mom averting breastfeeding, taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the baby decrease the danger of transmission in people who do breastfeed. Many of these measures are nevertheless not available in the developing world. 75 If blood contaminates food during pre- it may introduce a threat 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 in charge of long-duration sicknesses with a very 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 (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that's transported along 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, allowing the virus and its own host cell to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, generating viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle afresh and new RNA genomes. 84

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HIV is now known to distribute between CD4 T cells by two parallel courses: 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 can also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std Test nearest Thomasville, Alabama. 86 87 The hybrid distributing mechanisms of HIV contribute to the continuing replication of the virus against antiretroviral therapies. 85 88

There is a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood following the virus enters the body. During primary infection, the amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a marked drop in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell response is thought to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to a better prognosis and slower disease progression, though it doesn't get rid of the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight illnesses or kill cells that are cancerous. 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 may 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 generate 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 someone is infected, the majority of CD4 T cell loss happens during the first weeks of disease, especially in the intestinal mucosa, which harbors most of the lymphocytes found in the body. 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 gain access to 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 seeks out and destroys CCR5 expressing CD4 T cells during acute disease. The disease is eventually controlled by 98 A vigorous immune response and starts the latent period. CD4 T cells in mucosal tissues remain especially affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the chronic period. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of several HIV gene products and also the immune response to HIV replication that is ongoing. It is also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Thomasville 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 advised by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers only find when AIDS or acute immunodeficiency is now evident, they are infected at an advanced stage of the disease. Std Test near Thomasville AL. 27

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Antibody evaluations in kids younger than 18months are usually wrong because of the continued presence of maternal antibodies 102 Consequently 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 lots of areas simply wait the kid is old enough for antibody testing that is accurate or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Thomasville Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 103 which represented a considerable increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated disease for surveillance purposes: the WHO disease 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 embraced in developed nations. Since the WHO 's staging system doesn't require laboratory evaluations, it is satisfied to the resource-restricted conditions seen in developing countries, where it may also be utilized to help guide clinical management. Despite their differences, both systems enable comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by about 80% over the long term. 106 When condoms are used 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 offer an equivalent level of protection. Std Test nearest Thomasville. 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 inclination 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, both UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female to male HIV transmission in 2007 in areas using a high rates of HIV. 112 Nonetheless, whether it shields against male to female transmission is challenged, 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 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 vulnerability among circumcised men may cause more sexual risk taking behaviour, thereby negating its prophylactic effects. 119

Plans supporting sexual abstinence don't appear to influence subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally inferior. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A considerable minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearby AL, United States. 123 Voluntary counseling and testing individuals for HIV does not affect high-risk behavior in individuals who test negative but does increase condom use in individuals who test positive. 124 It is not known 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 productive way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test nearby Thomasville Alabama, United States. 125 TASP is related to a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (homework) 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 effective in intravenous drug users with a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

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

The World Health Organization and United States advocates antiretrovirals in individuals of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it's advised that it is continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desirable outcome 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 degrees drop 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 successful in more than 95% of individuals during the very first year. 27

Advantages of treatment contain a reduced danger of death as well as a decreased risk of progression to AIDS. Std Test in Thomasville, Alabama. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a reduced danger of transmission to sexual partners of the disease and a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on compliance. 27 Rationales 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 issue with some medications, 152 47% of people who wanted they were being taken by them in middle and low income nations as of 2010 143 as well as the rate of adherence is comparable in low income and high-income countries. 153

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