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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or long-term HIV. 1 Without treatment, this second period of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are few or no symptoms in the beginning, close to the end of the stage lots of 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 crotch) for over three to six months. Std Test closest to Meadow Valley, California. Meadow Valley, 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 proportion (about 5%) keep high rates 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 individuals who maintain 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 contaminated. Meadow Valley 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 incidence of specific disorders in association with an HIV infection. Std Test nearby Meadow Valley California, United States. 26 In the lack of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common 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 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 common cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, which is the initial sign of AIDS in 3 to 4% and is the cause of death of almost 16% of individuals with AIDS. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently in those with AIDS because of 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 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 person. 11 The bulk 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 nations. 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. 49 About 15% of homosexual and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std Test near me Meadow Valley.

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

The 2nd most frequent mode 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 risk from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test closest to CA United States. 63 The risk of acquiring 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 act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in some areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed countries the risk 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 instance, 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's estimated that up to 15% of HIV infections in these areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test nearby CA United States. 11 68 Although rare due to screening, it is likely 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 worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals 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 danger of mother-to-child infection may be reduced to about 1%. 73 Prophylactic treatment involves the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in people who do breastfeed. Many of these measures are yet not obtainable in the developing world. 75 If food is contaminated by blood during pre- chewing it may introduce a risk of transmission. 71

HIV is a member of the genus Lentivirus , 79 part of the family Retroviridae 80 Lentiviruses share many morphological and biological features. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration sicknesses using 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's transported together with the viral genome in the virus particle. The consequent viral DNA is subsequently imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once integrated, the virus may become latent, allowing its host cell and the virus to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle over. 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 uses crossed spreading mechanisms. 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 process of cell-to-cell spread. Std Test nearby Meadow Valley, California. 86 87 The hybrid spreading mechanics of HIV lead to the virus's continuing replication against antiretroviral treatments. 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 level 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 always 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 believed to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it does not eliminate the virus a great CD8 T cell response has been linked to slower disease progression along with 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 crucial to the immune response and without them, the body cannot fight diseases 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 factor. During the chronic period, the results 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

While the symptoms of immune deficiency feature of AIDS do not appear for decades after a person is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, particularly during the first weeks of disease. 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 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 disease. 98 A vigorous immune response controls the disease and begins the latent stage. CD4 T cells in mucosal tissues stay particularly changed. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the chronic stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of several HIV gene products and the immune response to HIV replication that is continuing. Additionally it is 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

Meadow Valley, CA Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Moreover, testing is recommended for those at high risk, which comprises anyone. 27 In many areas of the planet, a third of HIV carriers simply discover they're infected at an advanced stage of the disease when acute immunodeficiency or AIDS is now apparent. Std Test closest to Meadow Valley CA. 27

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Antibody evaluations in kids younger than 18months are usually wrong due to the continued existence 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 trusted PCR testing and several places just wait until either symptoms develop or the kid is old enough for accurate antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Meadow Valley Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which represented a substantial increase compared to preceding years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 and the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently adopted in developed countries. Since the WHO 's staging system does not require laboratory evaluations, it's satisfied to the resource-restricted states seen in developing countries, where it may 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 about 80% over the long term. 106 When condoms are used consistently by a couple in which one person 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 in Meadow Valley. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise 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 men 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 areas with a high rates of HIV in 2007. 112 Nonetheless, whether it shields against male to female transmission is disputed, 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, nevertheless, 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 fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, thereby negating its preventive effects. 119

Programs supporting sexual abstinence don't appear to affect subsequent HIV danger. 120 Signs of any gain from peer education is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A significant minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test nearest CA, United States. 123 Voluntary counseling and testing people for HIV will not change risky behavior in those 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 effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely productive way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test near Meadow Valley 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 drugs tenofovir , with or without emtricitabine , is effective 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 might also be effective in intravenous drug users with a study finding a drop in danger 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 kinds, or "classes," of antiretroviral agents. 144 Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in folks of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 After 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 begun. 27 The desired outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is powerful are initially advocated after four weeks and once degrees drop below 50copies/mL tests every three to six months are typically sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is effective in more than 95% of folks during the first year. 27

Benefits of treatment contain a reduced danger of departure and also a reduced risk of progression to AIDS. Std Test closest to Meadow Valley California. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased risk of transmission to sexual partners of the illness and a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 27 Rationales 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 price is an important problem with some drugs, 152 47% of people who wanted they were being taken by them in middle and low income nations as of 2010 143 and the speed of adherence is comparable in low-income and high-income countries. 153

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