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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic 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 at first, close to the end of the phase a lot of people experience gastrointestinal problems, weight loss, fever and muscle pains. 1 Between 50 and 70% of individuals also develop persistent generalized lymphadenopathy , defined 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 near me Flagstaff Arizona. Flagstaff, AZ 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 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 controllers or long term nonprogressors (LTNP). 31 Another group consists of those who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent approximately 1 in 300 persons that are contaminated. Flagstaff Arizona 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 nearby Flagstaff Arizona United States. 26 In the lack 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 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 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 individuals with HIV. 35 The second most common cancer is lymphoma, which is the initial indication of AIDS in 3 to 4% and is the cause of death of nearly 16% of people who have AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior 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 common 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 routine of transmission varies significantly among states. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this population accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of gay and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test in Flagstaff.

With respect to unprotected heterosexual contacts, estimates 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 countries. 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 act; the equivalent approximations for high-income nations 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 especially 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's still present. 53 The danger from receiving oral sex has been described as "virtually nil"; 54 nevertheless, a couple cases are 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 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 contaminated blood or blood product, or medical shots 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 AZ United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per act and the hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations 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 example, in the UK 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'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 nearby AZ United States. 11 68 Although rare because of screening, it will be 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 causing infection in the infant. 73 74 This is the third most common manner in which HIV is transmitted worldwide. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in those who also 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 may be reduced to about 1%. 73 Preventive treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the danger of transmission in those who do breastfeed. Many of these measures are nevertheless not accessible the developing world. 75 If food is contaminated by blood during pre- it might present a risk of transmission. 71

HIV is an associate 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 in charge of long-duration sicknesses 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 (turn 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 cofactors. 82 Once incorporated, the virus may become latent, enabling its particular host cell and the virus to avoid detection by the immune system. 83 Instead, the virus might be transcribed, producing viral proteins that are packaged and discharged from the cell as new virus particles that begin 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 uses hybrid spreading mechanisms. 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 process of cell-to-cell spread. Std Test near me Flagstaff, Arizona. 86 87 The hybrid distributing mechanics of HIV lead to the virus's ongoing replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood, after the virus enters the body. During primary infection, the degree 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 nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell reaction is believed to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was linked to a better prognosis as well as slower disease progression, though it does not get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are essential 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 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 stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells seem to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency feature of AIDS do not appear for decades after someone is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, especially during the very first weeks of disease. 95 The reason for 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 gain access to the cells, whereas merely a little 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 infection. The disease is eventually controlled by 98 A vigorous immune response and begins the latent stage. CD4 T cells in mucosal tissues stay particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the long-term period. 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 and several HIV gene products to continuing HIV replication. It's also 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

Flagstaff AZ 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 advocated 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 areas of the planet, a third of HIV carriers simply find when severe immunodeficiency or AIDS is now evident they're infected at an advanced period of the disorder. Std test near me Flagstaff, AZ. 27

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Antibody evaluations in children younger than 18months are typically incorrect due to the ongoing existence 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 a lot of places simply wait until either symptoms develop 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 aware of their HIV status. Flagstaff std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which signified a significant increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance purposes: 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 nations. Since the WHO 's staging system does not need lab evaluations, it's satisfied to the resource-controlled conditions seen in developing countries, where it can be used to help guide clinical management. Despite their differences, the two systems permit comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger 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 suggest that female condoms may provide an equivalent degree of protection. Std test near me Flagstaff. 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 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female to male HIV transmission in regions using a high rates of HIV in 2007. 112 However, whether it protects against male to female transmission is disputed, 113 114 and whether it is of benefit 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 alternative with men who have sex with men. 118 Some experts fear that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behavior, hence negating its preventive effects. 119

Programs encouraging sexual abstinence do not seem to change subsequent HIV danger. 120 Signs of any advantage from peer education is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A large minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std test nearest AZ, United States. 123 Voluntary counseling and testing individuals for HIV doesn't affect hazardous behavior in those who test negative but does raise condom use in individuals who test positive. 124 It is not understood whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely effective method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test near Flagstaff Arizona, 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 young heterosexuals in Africa. 109 It might also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

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

The World Health Organization and United States advocates antiretrovirals in folks of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's recommended that it's continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is successful are initially recommended after four weeks and once levels drop below 50copies/mL checks every three to six months are generally sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of folks during the very first year. 27

Benefits of treatment contain a reduced risk of death as well as a reduced risk of progression to AIDS. Std test nearest Flagstaff, Arizona. 147 In the developing world treatment also enhances physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a reduced danger of transmission to sexual partners of the disease and also a reduction in mother-to-child transmission. 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 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 wanted them were taking them in the rate of adherence as well as middle and low income countries as of 2010 143 is similar in low income and high income states. 153

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