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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 infection can last from around three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are no or few symptoms initially, near the end of this phase many people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also grow 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 nearby Camptonville California. Camptonville CA 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 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 accountants or long term nonprogressors (LTNP). 31 Another group consists of people who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent around 1 in 300 contaminated persons. Camptonville California 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 infection. Std test nearest Camptonville California United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alarm to the existence of AIDS are pneumocystis pneumonia (40%), cachexia in the kind of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals 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 common cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first sign of AIDS in 3 to 4% and is the cause of death of almost 16% of people with AIDS. 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 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 yet, 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 specific people accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of homosexual and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std test near me Camptonville.

With regard 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 nations. 51 In low-income countries, the danger 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 states are 0.04% per action for female-to-male transmission, and 0.08% per act for male-to-female transmission. 51 The risk 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 was described as "virtually nil"; 54 yet, a couple cases are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings involving 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 next most common way 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 action, with an average of 0.8%. Std test nearby CA United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the risk 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 a few places more than 80% of individuals 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 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 risk 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 infected blood and blood products, representing between 5% and 10% of global infections. Std Test closest to CA United States. 11 68 Although rare because of screening, it is possible to get HIV from organ and tissue transplantation 69

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HIV could be transmitted from mother to child during pregnancy, during delivery, or through breast milk resulting in infection in the baby. 73 74 This is the third most common way 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 people who also breastfeed 35%. 73 As of 2008, perpendicular 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 Prophylactic treatment includes the mom administering antiretroviral drugs to the newborn, averting breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the infant decline the risk of transmission in those who do breastfeed. Many of these measures are nevertheless not available in the developing world. 75 If food is contaminated by blood during pre- it may pose a danger of transmission. 71

HIV is a part 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 a 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 integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once integrated, the virus may become latent, enabling its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins which 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 uses crossed propagating mechanics. 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 procedure of cell-to-cell spread. Std test near me Camptonville California. 86 87 The hybrid distributing mechanisms of HIV lead to the virus's on-going replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, resulting in plenty 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 reaction 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 later with antibody generation, or seroconversion The CD8 T cell response is regarded as significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't eliminate the virus a great CD8 T cell response was linked to slower disease progression and also a better prognosis. 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 critical to the immune response and without them, the body cannot fight infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the long-term 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 results of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells seem 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 years after someone is infected, the majority of CD4 T cell loss occurs during the very first weeks of illness, particularly in the intestinal mucosa, which harbors the majority 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 obtain access to the cells, whereas merely a tiny 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 destroys CCR5 expressing CD4 T cells during acute disease and seeks out. 98 A vigorous immune response controls the infection and initiates the clinically 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 chronic period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of the immune response and several HIV gene products to continuing HIV replication. It's also linked to the dysfunction 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

Camptonville CA 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 advocated by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many sections of the world, a third of HIV carriers just discover they are infected at an advanced phase of the disease when acute immunodeficiency or AIDS is now apparent. Std Test nearby Camptonville, CA. 27

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Antibody tests in kids younger than 18months are typically wrong due to the continued presence of maternal antibodies 102 Consequently 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 several areas simply wait the child is old enough for accurate antibody testing or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Camptonville 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 preceding years. 103

Two principal 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 nations. Since the WHO 's staging system does not require lab tests, it is suited to the resource-restricted conditions seen in developing countries, where it can be used to help guide clinical management. Despite their differences, both 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 by a couple in which one individual is infected, the speed of HIV infection is less than 1% per year. 107 There is some evidence to suggest that female condoms may offer an equal level of protection. Std Test near me Camptonville. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems 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 due to its tendency to cause vaginal and rectal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". 111 Due to these studies the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female-to-male HIV transmission in 2007 in areas using a high rates of HIV. 112 However, 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 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 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 Signs of any advantage from peer instruction is equally inferior. 121 Comprehensive sexual education provided at school may fall high risk behavior. 122 A significant minority of young people continues to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test near me CA, United States. 123 Voluntary counseling and testing individuals for HIV does not influence hazardous behavior in individuals who test negative but does raise 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 an extremely effective method to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearby Camptonville California United States. 125 TASP is connected 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 successful in a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It may also be effective in intravenous drug users with a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

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

United States and the World Health Organization advocates antiretrovirals in individuals of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is started it's recommended that it's continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desirable result 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 degrees fall below 50copies/mL tests every three to six months are typically sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of people during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS as well as a decreased risk of departure. Std Test in Camptonville California. Physical and mental health also enhances. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a reduced risk of transmission of the illness to sexual partners and also a drop in mom-to-child transmission. 144 The effectiveness of treatment depends to a large 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 complexity 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 medicines, 152 47% of people who wanted they were being taken by 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 countries. 153

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