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The first 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 last from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms in the beginning, near 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 develop persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test near Larkfield California. Larkfield 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 little percentage (about 5%) keep high rates 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 individuals who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 persons that are contaminated. Larkfield 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 nearby Larkfield California, United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alert to the presence 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

People with AIDS have a higher 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 typical cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of individuals with AIDS. 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 inner 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 common 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 individuals 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 men, with this population 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 nearest Larkfield.

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 states. 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 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 danger from getting oral sex was described as "virtually nil"; 54 nevertheless, a couple 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 act. 51

The second 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 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 action, with an average of 0.8%. Std test nearest CA, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to contaminated 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 regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the risk 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 danger 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 regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std test nearby 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 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 manner 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 individuals who also breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventive treatment involves the mom averting 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 infant decline the danger of transmission in those who do breastfeed. Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it may pose a risk 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 responsible for long-duration sicknesses using a lengthy 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 along 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 may become latent, enabling the virus and its host cell to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, producing viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel routes: cell free spread and cell-to-cell spread, i.e. it applies crossed 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 for cell-to-cell spread. Std Test near Larkfield California. 86 87 The hybrid spreading mechanisms of HIV lead to the on-going replication of the virus against antiretroviral therapies. 85 88

There is a period of rapid viral replication, leading to plenty 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 marked fall in the number of circulating CD4 T cells. The acute viremia is nearly invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell response is thought to be important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it does not remove the virus a good CD8 T cell response has been associated with slower disease progression and a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are essential 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 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 might also be a variable. 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after someone is infected, the bulk of CD4 T cell loss happens during the first weeks of illness, especially in the intestinal mucosa, which harbors most of the lymphocytes found in the body. 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 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 destroys CCR5 expressing CD4 T cells during acute illness and seeks out. 98 A vigorous immune response initiates the latent period and controls the disease. CD4 T cells in mucosal tissues stay particularly affected. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic period. 99 Immune activation, which is represented 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 continuing HIV replication. Additionally it is linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Larkfield 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 advised by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Additionally, testing is suggested for those at high risk, which includes anyone. 27 In many sections of the planet, a third of HIV carriers just discover when AIDS or acute immunodeficiency is now evident, they are infected at an advanced stage of the disease. Std Test in Larkfield CA. 27

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Antibody evaluations in kids younger than 18months are normally inaccurate due to the ongoing presence of maternal antibodies 102 Thus 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 reliable PCR testing and several areas simply wait until either symptoms grow or the child is old enough for precise antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Larkfield 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 main 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 often adopted in developed countries. Since the WHO 's staging system doesn't require laboratory tests, it is suited to the resource-restricted states encountered in developing countries, where it can also be utilized 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 consistently by a couple in which one person is infected, the speed of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equivalent degree of protection. Std test closest to Larkfield. 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 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female-to-male HIV transmission in 2007 in places using a high rates of HIV. 112 Nevertheless, whether it protects against male to female transmission is contested, 113 114 and whether it's of advantage 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 as an option with men who have sex with men. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, thus negating its preventative effects. 119

Plans encouraging sexual abstinence don't appear to influence subsequent HIV danger. 120 Signs of any advantage from peer instruction is equally poor. 121 Complete sexual education provided at school may fall 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 risk of becoming infected with HIV. Std Test in CA, United States. 123 Voluntary counselling and testing people for HIV will not change hazardous behavior in those who test negative but does increase condom use in individuals who test positive. 124 It is not understood whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an effective way to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std Test near Larkfield 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 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 successful in intravenous drug users with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixes (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "groups," 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 contain: 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 urges antiretrovirals in folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is started it's recommended that it's continued without breaks or "holidays". 27 Many people are diagnosed just after treatment ideally should have started. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is effective are initially urged after four weeks and once degrees fall below 50copies/mL checks every three to six months are usually adequate. 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 first year. 27

Benefits of treatment contain a reduced risk of progression to AIDS and also a reduced danger of departure. Std Test near me Larkfield, California. 147 In the developing world treatment also enhances physical and mental health. 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 as well as a reduction in mom-to-child transmission. The effectiveness of treatment depends to a sizable 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 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 medicines, 152 47% of those who wanted them were taking them in the rate 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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