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The initial symptoms are followed by a period called asymptomatic HIV, clinical latency, or continual HIV. 1 Without treatment, this second phase of the natural history of HIV infection 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 in the beginning, close to the end of this period many people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also develop persistent generalized lymphadenopathy , characterized 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 El Cajon California. El Cajon, 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 small percentage (about 5%) keep high levels 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 keep 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 individuals that are infected. El Cajon, 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 diseases in association with an HIV infection. Std test in El Cajon California, United States. 26 In the absence of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring initial 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 an increased 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 typical cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people with AIDS and is the first hint of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 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 individual. 11 The majority 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 countries. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this population 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 homosexual and bisexual men have HIV. 49 50 Std test near me El Cajon.

With respect 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 nations. 51 In low-income nations, the threat of female to male transmission is estimated as 0.38% per act, and of male to female transmission as 0.30% per act; the equivalent estimates for high-income nations are 0.04% per act for female-to-male transmission, and 0.08% per act 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 homosexual contacts. 51 52 While the risk of transmission from oral sex is relatively low, it is still present. 53 The risk from receiving oral sex has been described as "almost nil"; 54 yet, a couple cases have been 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 was estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The second most common 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 injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test in CA United States. 63 The risk of getting HIV from a needle stick from an HIV-infected person 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 America intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in certain areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed countries the danger 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 instance, 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 appropriately screened (as of 2008), 67 and it's 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 me CA, United States. 11 68 Although rare due to screening, it is likely to acquire HIV from organ and tissue transplantation 69

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HIV may 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 globally. 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, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventive treatment includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the risk of transmission in people who do breastfeed. Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it may present a threat 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 with a 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 is 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 co-factors. 82 Once integrated, the virus might become latent, allowing its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, creating viral proteins which are packaged and released 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 understood to spread between CD4 T cells by two parallel routes: 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 procedure for cell-to-cell spread. Std Test nearest El Cajon, California. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's continuing replication against antiretroviral therapies. 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 degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a noticeable drop in the amount of circulating CD4 T cells. The acute viremia is almost always related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell reaction is thought to be significant in controlling virus levels, 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 will not eliminate the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are crucial 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 acute and chronic phases. 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 might 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 decrease in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for decades 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 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 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 initiates the clinically latent stage and controls the disease. CD4 T cells in mucosal tissues remain particularly changed. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic phase. 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 several HIV gene products as well as the immune response to HIV replication that is ongoing. 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

El Cajon CA Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Moreover, 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 obvious, they are infected at an advanced period of the disorder. Std Test closest to El Cajon CA. 27

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Antibody tests in children younger than 18months are normally erroneous because of the continued existence of maternal antibodies 102 Hence HIV infection 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 reliable PCR testing and lots of areas just wait the kid is old enough for exact antibody testing or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. El Cajon Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a considerable increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance purposes: the WHO disease 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 adopted in developed nations. Since the WHO 's staging system doesn't require lab tests, it's suited to the resource-restricted conditions encountered in developing countries, where it can also be utilized to help direct clinical management. Despite their differences, both systems enable 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 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 closest to El Cajon. 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 increase the risk of transmission due to its inclination 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 recommended 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 shields against male to female transmission is contested, 113 114 and whether it's of benefit in developed nations 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 option. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, hence negating its preventive effects. 119

Plans encouraging sexual abstinence don't appear to impact subsequent HIV risk. 120 Signs of any benefit from peer education is equally poor. 121 Comprehensive sexual education provided at school may decrease high risk behaviour. 122 A large minority of young people continues to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test near me CA, United States. 123 Voluntary counselling and testing individuals for HIV doesn't affect high-risk behaviour 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 effective in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an productive method to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test in El Cajon California United States. 125 TASP is related to 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 young heterosexuals in Africa. 109 It may also be effective 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 blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, 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 including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in folks of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have begun. 27 The desired results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is successful are initially urged after four weeks and once levels drop 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 criteria treatment is effective in more than 95% of individuals during the first year. 27

Benefits of treatment include a reduced risk of departure as well as a decreased risk of progression to AIDS. Std Test in El Cajon, California. Physical and mental health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased danger of transmission to sexual partners of the disease and also a drop in mom-to-child transmission. 144 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 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 medications, 152 47% of people who needed they were being taken by them in middle and low income countries as of 2010 143 as well as the speed of adherence is similar in low income and high-income nations. 153

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