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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 period of the natural history of HIV disease can continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are no or few symptoms in the beginning, near the end of the stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people 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 me Gerber California. Gerber CA 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 levels of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV accountants or long-term nonprogressors (LTNP). 31 Another group consists of those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 contaminated persons. Gerber, 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 closest to Gerber California United States. 26 In the lack of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alarm to the presence 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

People 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 frequent cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people who have AIDS and is the first indication of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner 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 common 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 people of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this specific 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 Gerber.

With regard to unprotected heterosexual contacts, estimates of the danger 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 danger 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 especially 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 comparatively low, it's still present. 53 The danger from getting oral sex has been described as "nearly nil"; 54 yet, a few instances have been 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 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 infected blood or blood product, or medical shots with unsterilized equipment. The danger from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test nearest CA, United States. 63 The risk of getting HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per act and the risk following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some regions 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 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 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'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 infections. Std Test nearby CA, United States. 11 68 Although rare because of screening, it will be possible 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 way in which HIV is transmitted globally. 11 In the lack 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 appropriate treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment involves the mom avoiding breastfeeding taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the baby decline the risk of transmission in people who do breastfeed. 76 Many of these measures are yet not obtainable in the developing world. 75 If blood contaminates food during pre- it might introduce a threat 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 accountable for long-duration sicknesses using 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 (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 integrated, the virus may become latent, enabling the virus and its particular host cell to prevent detection by the immune system. 83 Instead, the virus may be transcribed, creating new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle anew. 84

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HIV is now understood to spread between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it uses 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 of cell-to-cell spread. Std Test in Gerber, California. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's on-going replication against antiretroviral therapies. 85 88

After the virus enters the body there's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the amount 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 invariably 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 regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it will not get rid of the virus a good 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 This allows opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight infections or kill cancerous cells. 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 period, the results of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear 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 a long time 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 within the body. 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 just a little 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 destroys CCR5 expressing CD4 T cells during acute disease and seeks out. 98 A vigorous immune response initiates the latent phase and controls the infection. CD4 T cells in mucosal tissues remain especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the chronic stage. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products and also 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

Gerber, CA 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 advised 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 planet, a third of HIV carriers simply discover they are infected at an advanced phase of the disorder when AIDS or severe immunodeficiency is now apparent. Std Test near Gerber, CA. 27

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Antibody tests in kids younger than 18months are generally inaccurate due to the ongoing presence of maternal antibodies 102 Thus 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 many places simply wait the child is old enough for antibody testing that is precise or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Gerber Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 103 which signified a considerable increase compared to previous years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disease for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 and the CDC classification system for HIV infection 104 The CDC 's classification system is more often embraced in developed nations. Since the WHO 's staging system doesn't need lab evaluations, it's suited to the resource-restricted states encountered in developing countries, where it may 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 approximately 80% over the long term. 106 When condoms are used consistently 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 degree of protection. Std Test near Gerber. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce 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 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 method 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 challenged, 113 114 and whether it's of advantage in developed countries 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 advocate for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk taking behavior, thereby negating its preventative effects. 119

Programs supporting sexual abstinence do not seem to change subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally poor. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A significant minority of young people proceeds to participate 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 people for HIV doesn't change risky behavior in those who test negative but does raise condom use in individuals who test positive. 124 It isn't 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 nearby Gerber California United States. 125 TASP is connected 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 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 using a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. 144 Initially therapy is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue 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

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

Advantages of treatment include a reduced risk of progression to AIDS as well as a reduced risk of departure. Std test closest to Gerber California. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a decreased danger of transmission of the illness to sexual partners and also a drop in mother-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Motives for non-adherence include poor access to medical care, 149 inadequate 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 Even though cost is an important issue with some drugs, 152 47% of those who desired them were taking them in middle and low income countries as of 2010 143 and also the speed of adherence is similar in low-income and high income states. 153

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