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The first symptoms are followed by a period called clinical latency, asymptomatic HIV, or persistent HIV. 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 generally there are few or no symptoms in the beginning, close to the end of this period lots 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 Toyei, Arizona. Toyei, AZ Std Test. 2

Although most HIV 1 infected people have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a small percentage (about 5%) retain high 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 anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 individuals that are contaminated. Toyei 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 disorders in association with an HIV disease. Std Test closest to Toyei Arizona, United States. 26 In the lack of specific treatment, around half of individuals 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 type of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have an increased 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 common cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, that is the first hint 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 those with AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids as well as the white portion 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 individual. 11 The majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among states. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, with this public 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 gay and bisexual men have HIV. 49 50 Std Test near me Toyei.

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 nations. 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 estimates for high-income states are 0.04% per act 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 action in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is relatively low, it is still present. 53 The risk from getting oral sex was described as "almost nil"; 54 nonetheless, a couple instances 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 action. 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 contaminated blood or blood product, or medical injections with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std test nearby 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 act and the threat 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 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 countries the risk 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 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 regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test near AZ, United States. 11 68 Although rare because of screening, it really is likely to get HIV from tissue and organ transplantation 69

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HIV could 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 internationally. 11 In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who additionally breastfeed 35%. 73 As of 2008, vertical 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 Preventive treatment includes the mother preventing 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 infant decline the danger of transmission in those who do breastfeed. Many of these measures are however not obtainable in the developing world. 75 If food is contaminated by blood during pre- chewing it may present 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 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 entry 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 consequent 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 Alternatively, the virus may be transcribed, creating viral proteins which are packaged and released 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 disperse 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 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 closest to Toyei Arizona. 86 87 The hybrid spreading mechanisms of HIV lead to the continuing replication of the virus against antiretroviral treatments. 85 88

There's a period of rapid viral replication, leading to plenty 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 response is accompanied by a marked drop in the number of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody production, or seroconversion The CD8 T cell reaction is thought to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been associated with a better prognosis and slower disease progression, though it does not get rid of the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are essential 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 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 stage, the consequences 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

Although the symptoms of immune deficiency feature of AIDS do not appear for many years after someone is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors most of the lymphocytes found in the body, especially during the very first weeks of disease. 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 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 illness. The disease is eventually controlled by 98 A vigorous immune response and initiates the clinically latent stage. CD4 T cells in mucosal tissues remain particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation continuing 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 also the immune response to ongoing HIV replication. It's 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

Toyei, AZ Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all folks 15years to 65years of age including all pregnant women. 101 Furthermore, testing is suggested for those at high risk, which includes anyone. 27 In many regions of the world, a third of HIV carriers only find when AIDS or severe immunodeficiency has become evident, they are infected at an advanced phase of the disease. Std test near me Toyei AZ. 27

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Antibody evaluations in children younger than 18months are normally wrong because of the ongoing presence 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 places simply wait until either symptoms develop or the child is old enough for exact antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Toyei Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were examined 103 which signified a significant increase compared to previous years. 103

Two principal 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 the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently adopted in developed countries. Since the WHO 's staging system does not need laboratory evaluations, it's satisfied to the resource-controlled states encountered in developing countries, where it can be used to help guide clinical management. Despite their differences, both systems allow comparison for statistical purposes. 2 24 104

Consistent condom use reduces the risk 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 imply that female condoms may offer an equal level of protection. Std test in Toyei. 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 vaginal and rectal 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 with a high rates of HIV. 112 Nonetheless, whether it protects 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, nevertheless, does that it be discussed as an alternative 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 preventative effects. 119

Programs supporting sexual abstinence don't seem to affect subsequent HIV risk. 120 Signs of any advantage from peer instruction is equally poor. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A sizeable minority of young people proceeds to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std Test near me AZ, United States. 123 Voluntary counselling and testing individuals for HIV does not influence high-risk behavior in individuals who test negative but does increase 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 people with HIV whose CD4 count 550 cells/L is an extremely productive way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test near me Toyei Arizona, United States. 125 TASP is associated with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications tenofovir , with or without emtricitabine , is successful 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 may also be successful in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

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

United States and the World Health Organization recommends 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 "holidays". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is powerful are initially advocated after four weeks and once levels drop below 50copies/mL checks every three to six months are generally sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of folks during the very first year. 27

Benefits of treatment include a decreased risk of death as well as a reduced risk of progression to AIDS. Std test near Toyei Arizona. Mental and physical health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a reduced danger of transmission to sexual partners of the disease and also a decrease in mom-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 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 Even though cost is an important problem with some medications, 152 47% of those who desired them were taking them in low and middle income countries as of 2010 143 and also the rate of adherence is comparable in low-income and high-income countries. 153

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