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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 generally there are few or no symptoms initially, near 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 , 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 closest to Paradise Valley, Arizona. Paradise Valley AZ std test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the absence 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 individuals are classified as HIV controllers or long term nonprogressors (LTNP). 31 Another group consists of individuals who maintain a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent about 1 in 300 persons that are infected. Paradise Valley 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 occurrence of specific disorders in association with an HIV disease. Std Test near Paradise Valley Arizona, 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 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

People 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 frequent 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 almost 16% of people with AIDS and is the initial signal of AIDS in 3 to 4%. 35 Both these cancers are related to 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 frequent mode of transmission of HIV is through sexual contact with an infected person. 11 The majority 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 USA occurred among men who had sex with guys, with this particular people 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 bisexual and homosexual guys have HIV. 49 50 Std Test nearby Paradise Valley.

With regard 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 states. 51 In low income nations, the threat 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 estimates for high-income states are 0.04% per action for female-to-male transmission, and 0.08% per action 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's still present. 53 The danger from getting oral sex has been described as "virtually nil"; 54 nevertheless, a few cases 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 was estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The second most common way 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 injections with unsterilized equipment. The danger 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 AZ United States. 63 The danger of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in some areas 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 countries the danger 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 UK the threat 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 places come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std Test nearest AZ, 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 leading to infection in the baby. 73 74 This is the third most common manner 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, 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 Prophylactic treatment involves the mother administering antiretroviral drugs to the newborn, avoiding breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in those who do breastfeed. Many of these measures are however not obtainable in the developing world. 75 If blood contaminates food during pre- chewing it may introduce a risk of transmission. 71

HIV is a member 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 accountable for long-duration sicknesses with an extended 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 is transported together with the viral genome in the virus particle. The resulting 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 incorporated, the virus may become latent, enabling its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, creating 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 spread between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it applies hybrid propagating mechanics. 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 may also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std test near Paradise Valley, Arizona. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's on-going replication against antiretroviral treatments. 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 amount 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 reaction is thought to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was linked to a better prognosis along with slower disease progression, though it doesn't eliminate the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This permits 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 cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 stage, 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

Although the symptoms of immune deficiency feature of AIDS don't appear for years after a person is infected, the bulk of CD4 T cell loss happens during the very first weeks of illness, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body. 95 The reason for the preferential loss of mucosal CD4 T cells is that the majority of mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas only a tiny 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 infection. 98 A vigorous immune response eventually controls the disease and starts the latent stage. CD4 T cells in mucosal tissues remain particularly changed. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic stage. 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 the immune response as well as several HIV gene products to ongoing HIV replication. It is also linked to the breakdown 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

Paradise Valley, AZ Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of particular 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. 27 In many areas of the world, a third of HIV carriers simply discover they are infected at an advanced period of the disease when AIDS or acute immunodeficiency is now evident. Std test near me Paradise Valley, AZ. 27

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Antibody tests in kids younger than 18months are usually erroneous because of the ongoing existence of maternal antibodies 102 Hence 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 simply wait the kid is old enough for precise antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were aware of their HIV status. Paradise Valley std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were tested 103 which signified 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 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 often embraced in developed countries. Since the WHO 's staging system doesn't need lab evaluations, it is satisfied to the resource-controlled conditions encountered in developing countries, where it can also be used to help direct clinical management. Despite their differences, the two systems permit 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 individual 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 level of protection. Std test near me Paradise Valley. 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 tendency 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 the World Health Organization and UNAIDS advocated male circumcision as a way of preventing female to male HIV transmission in 2007 in places using a high rates of HIV. 112 Nevertheless, whether it shields against male-to-female transmission is contested, 113 114 and whether it is of advantage in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does recommend 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 perception of exposure among circumcised men may cause more sexual risk taking behavior, thereby negating its preventive effects. 119

Plans supporting sexual abstinence do not appear to impact subsequent HIV danger. 120 Evidence of any gain from peer education is equally poor. 121 Comprehensive sexual education provided at school may decrease high risk behavior. 122 A large minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test near AZ United States. 123 Voluntary counselling and testing individuals for HIV will not affect high-risk behaviour in individuals who test negative but does increase condom use in those 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 quite an productive method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test closest to Paradise Valley 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 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 young heterosexuals in Africa. 109 It might also be effective in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are blends (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 contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in people 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 "vacations". 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 determine if treatment is successful are initially recommended after four weeks and once amounts drop below 50copies/mL checks every three to six months are usually 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 individuals during the very first year. 27

Advantages of treatment include a reduced danger of death and a decreased risk of progression to AIDS. Std Test closest to Paradise Valley, Arizona. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added advantages include a reduced risk of transmission of the disease to sexual partners and a reduction in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Motives 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 issue with some medicines, 152 47% of those who wanted they were being taken by them in the rate of adherence and also middle and low income nations as of 2010 143 is comparable in low-income and high-income countries. 153

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