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The initial symptoms are followed by a period called asymptomatic HIV, clinical latency, or long-term HIV. 1 Without treatment, this second period 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 commonly there are no or few symptoms initially, close to the end of the stage lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the groin) for over three to six months. Std Test nearby Igo California. Igo 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%) keep elevated 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 those who keep a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent around 1 in 300 infected persons. Igo, 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 disease. Std test nearby Igo California United States. 26 In the absence of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial 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

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 common 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 nearly 16% of people with AIDS and is the initial hint of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and 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 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 public accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive 49 About 15% of bisexual and gay men have HIV. 49 50 Std test near me Igo.

With regard to unprotected heterosexual contacts, approximations of the danger 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 countries, the danger of female to male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per action; the equivalent approximations 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 danger of transmission from anal intercourse is particularly high, estimated as 1.4-1.7% per act 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 receiving oral sex was described as "almost nil"; 54 however, 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 next most frequent 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 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 near CA, United States. 63 The danger 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 danger following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few areas 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 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 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 suitably screened (as of 2008), 67 and it's 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 diseases. Std test closest to CA, United States. 11 68 Although rare due to screening, it really is likely to acquire HIV from tissue and organ 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 internationally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals 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 can be reduced to about 1%. 73 Preventative treatment involves the mother administering antiretroviral drugs to the newborn, preventing 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 people who do breastfeed. Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- it might present a threat 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 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 (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resultant viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once integrated, the virus might become latent, allowing the virus and its particular host cell to prevent detection by the immune system. 83 Instead, the virus may be transcribed, creating viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle over and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it uses hybrid spreading 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 for cell-to-cell spread. Std test near me Igo, California. 86 87 The hybrid spreading mechanisms of HIV contribute to the virus's on-going replication against antiretroviral therapies. 85 88

There is a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood after 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 fall in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is thought to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was associated with slower disease progression as well as a better prognosis, though it does not get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are crucial to the immune response and weakens the immune system and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 phase, 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 decline in CD4 T cell numbers. 94

Even though 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 happens in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body, especially during the first weeks of illness. 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 gain 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 seeks out and destroys CCR5 expressing CD4 T cells during acute infection. 98 A vigorous immune response begins the latent period and eventually controls the disease. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term phase. 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 the immune response and several HIV gene products to HIV replication that is continuing. 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

Igo, CA Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the planet, a third of HIV carriers just discover they're infected at an advanced period of the disease when AIDS or acute immunodeficiency is now evident. Std test near Igo CA. 27

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Antibody tests in children younger than 18months are normally inaccurate due to the ongoing presence 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 many places simply wait the child is old enough for accurate antibody testing or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. Igo std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which represented a significant increase compared to preceding years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated ailment 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 frequently embraced in developed countries. Since the WHO 's staging system doesn't require lab evaluations, it is suited to the resource-controlled states encountered in developing countries, where it can also be used to help guide 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 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 offer an equivalent level of protection. Std test closest to Igo. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems 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 inclination 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, both the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female to male HIV transmission in places using a high rates of HIV in 2007. 112 Nevertheless, whether it shields against male to female transmission is contested, 113 114 and whether it's of benefit in developed countries 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 with men who have sex with men as an alternative. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, hence negating its preventative effects. 119

Plans encouraging sexual abstinence do not appear to influence subsequent HIV danger. 120 Signs of any gain 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 continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test in CA United States. 123 Voluntary counseling and testing individuals for HIV does not affect risky 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 a very effective way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test closest to Igo California, United States. 125 TASP is related to 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 effective in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be effective in intravenous drug users using a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially therapy is usually 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 Blends of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

United States and the World Health Organization advocates antiretrovirals in individuals of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it is recommended that it is continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have begun. 27 The desired result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is effective are initially advocated after four weeks and once levels drop below 50copies/mL tests every three to six months are generally adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of folks during the first year. 27

Advantages of treatment include a reduced danger of death as well as a reduced risk of progression to AIDS. Std Test nearby Igo, California. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced risk of transmission to sexual partners of the disease as well as a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a big part on compliance. 27 Motives 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 issue with some medicines, 152 47% of those who desired them were taking them in the speed of adherence and also low and middle income countries as of 2010 143 is similar in low-income and high-income states. 153

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