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The first symptoms are followed by a stage called continual HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second stage 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 typically there are few or no symptoms in the beginning, close to the end of the stage 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 near Tok Alaska. Tok AK 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 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 people who maintain a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 individuals that are contaminated. Tok Alaska 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 Tok Alaska United States. 26 In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alert 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

Individuals 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 hint of AIDS in 3 to 4% and is the cause of death of nearly 16% of people with AIDS. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often in those with AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior 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 person. 11 The bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 yet, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this specific 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 bisexual and gay guys have HIV. 49 50 Std Test near Tok.

With regard to unprotected heterosexual contacts, estimates of the risk 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 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 act; the equivalent approximations for high-income countries 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 danger of transmission from oral sex is comparatively low, it is still present. 53 The risk from getting oral sex was described as "nearly nil"; 54 however, 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 2nd 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 contaminated blood or blood product, or medical shots with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test nearby AK, 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 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 64 2009 and in certain regions more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the risk of acquiring 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 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 AK, United States. 11 68 Although rare due to screening, it's possible 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 leading to 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 risk of transmission before or during birth is around 20% and in individuals 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 danger of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment involves the mother averting 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 danger of transmission in those who do breastfeed. 76 Many of these measures are however not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it might introduce a risk 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 in charge of long-duration illnesses 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 (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 subsequently imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once incorporated, the virus may become latent, allowing its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins that are packaged and discharged 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 known to disperse between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it employs crossed propagating mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid then 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 nearby Tok Alaska. 86 87 The hybrid distributing mechanics of HIV contribute to the ongoing replication of the virus against antiretroviral treatments. 85 88

Following the virus enters the body there's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. 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 nearly always related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, 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. Though it will not get rid of the virus a good CD8 T cell response was associated with slower disease progression and a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are critical 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 acute and long-term 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 may 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 generate new T cells appear to account for the slow decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS do not appear for decades after an individual is infected, the bulk of CD4 T cell loss happens during the very first weeks of disease, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in 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 gain access to the cells, whereas only a little 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 illness. The disease is eventually controlled by 98 A vigorous immune response and begins the clinically latent stage. CD4 T cells in mucosal tissues stay especially affected. 98 Constant HIV replication causes a state of generalized immune activation lasting throughout the chronic period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the action of several HIV gene products and the immune response to continuing HIV replication. Additionally it is 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

Tok AK std test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence 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 Furthermore, testing is suggested for those at high risk, which comprises anyone. 27 In many regions of the planet, a third of HIV carriers just find when AIDS or acute immunodeficiency has become apparent, they're infected at an advanced stage of the disorder. Std test in Tok, AK. 27

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Antibody evaluations in children younger than 18months are generally incorrect due to the ongoing presence of maternal antibodies 102 Thus 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 just wait until either symptoms grow or the kid is old enough for antibody testing that is precise. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. Tok std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a significant increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disorder for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 and also the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently embraced in developed countries. Since the WHO 's staging system does not need lab evaluations, it's suited to the resource-controlled states encountered in developing countries, where it can be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used 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 equivalent degree of protection. Std Test nearest Tok. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears 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 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 way 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's of benefit in developed countries 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 with men who have sex with men as an alternative. 118 Some experts fear that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behavior, hence negating its preventative effects. 119

Plans supporting sexual abstinence do not appear to affect subsequent HIV risk. 120 Signs of any gain from peer education is equally poor. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A significant minority of young people proceeds to participate in high risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test in AK, United States. 123 Voluntary counseling and testing people for HIV doesn't change risky behaviour in individuals who test negative but does raise condom use in those who test positive. 124 It isn't 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 an extremely effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test closest to Tok Alaska United States. 125 TASP is associated with 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 powerful 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 alternatives are combinations (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially treatment is generally 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 Blends of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is started it's recommended that it is continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired result of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to find out if treatment is effective are initially recommended after four weeks and once degrees drop below 50copies/mL checks every three to six months are typically sufficient. 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 first year. 27

Advantages of treatment include a decreased risk of progression to AIDS and a reduced danger of departure. Std Test near me Tok Alaska. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced risk of transmission of the illness to sexual partners and a drop in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable 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 intricacy of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 though cost is an important issue with some medications, 152 47% of people who needed they were being taken by them in middle and low income countries as of 2010 143 and also the rate of adherence is similar in low income and high income countries. 153

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