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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or continual HIV. 1 Without treatment, this second phase of the natural history of HIV infection can continue from around 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 phase a lot 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 Nicolaus, California. Nicolaus, CA Std Test. 2

Although most HIV-1 infected people have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a little percentage (about 5%) retain elevated levels of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV controllers or long term nonprogressors (LTNP). 31 Another group consists of individuals 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 individuals that are infected. Nicolaus, 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 disease. Std test near Nicolaus California, United States. 26 In the lack of specific treatment, around half of people 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 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 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 people with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of nearly 16% of people who have AIDS and is the first sign of AIDS in 3 to 4%. 35 Both these cancers are associated 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 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this specific 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 homosexual men have HIV. 49 50 Std Test near Nicolaus.

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 approximations for high-income states are 0.04% per action for female-to-male transmission, and 0.08% per action for male to female transmission. 51 The danger 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 relatively low, it's still present. 53 The risk from getting oral sex has been described as "virtually nil"; 54 however, a few instances are 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 has been estimated as 2.4% per action and male-to-female transmission as 0.05% per act. 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 shots with unsterilized equipment. The danger 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 action and the risk following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in some places 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 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 instance, in the united kingdom the threat 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 areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test closest to CA United States. 11 68 Although rare because of screening, it's 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 resulting in infection in the infant. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the absence of treatment, the risk of transmission before or during birth is around 20% and in people who also breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the risk of mother-to-child infection can 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 baby decrease the danger 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 may pose 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 features. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration sicknesses with a lengthy 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's 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 co-factors. 82 Once incorporated, the virus may become latent, enabling the virus and its particular host cell to avoid detection by the immune system. 83 Instead, the virus could be transcribed, creating new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle afresh. 84

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HIV is now known to disperse between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it employs 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 process of cell-to-cell spread. Std test nearest Nicolaus, California. 86 87 The hybrid distributing mechanisms of HIV lead to the virus's continuing replication against antiretroviral therapies. 85 88

After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable drop in the number of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, 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. A great CD8 T cell response has been associated with slower disease progression and also a better prognosis, though it does not eliminate the virus. 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 diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the long-term 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 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for decades after an individual is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, particularly during the very first weeks of illness. 95 The reason for 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 disease. 98 A vigorous immune response eventually controls the infection and initiates the latent stage. CD4 T cells in mucosal tissues remain especially changed. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the chronic stage. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of several HIV gene products as well as the immune response to HIV replication that is continuing. It is 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

Nicolaus, 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 folks 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which comprises anyone. 27 In many sections of the planet, a third of HIV carriers just find when acute immunodeficiency or AIDS has become obvious they're infected at an advanced period of the disorder. Std Test closest to Nicolaus CA. 27

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Antibody evaluations in kids younger than 18months are generally inaccurate because of the continuing 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 dependable PCR testing and many areas just wait until either symptoms grow or the kid is old enough for antibody testing that is accurate. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Nicolaus std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which signified a substantial increase compared to preceding years. 103

Two primary 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 along with 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 does not require laboratory tests, it's suited to the resource-restricted conditions seen in developing countries, where it can 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 by a couple in which one individual is infected, the speed 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 in Nicolaus. 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 because of 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 advocated male circumcision as a method of preventing female to male HIV transmission in 2007 in areas with a high rates of HIV. 112 Nonetheless, whether it protects against male-to-female transmission is questioned, 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, 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 worry that a lower understanding of exposure among circumcised men may cause more sexual risk taking behaviour, thereby negating its preventative effects. 119

Programs supporting sexual abstinence don't appear to affect subsequent HIV danger. 120 Evidence of any benefit from peer instruction is equally inferior. 121 Comprehensive sexual education provided at school may fall high risk behavior. 122 A sizeable minority of young people continues to participate in high risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test nearby CA, United States. 123 Voluntary counseling and testing people for HIV does not influence risky behaviour 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 effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test near me Nicolaus California, United States. 125 TASP is associated with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the drugs tenofovir , with or without emtricitabine , is effective in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It can also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixes (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially treatment is commonly 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 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 Once treatment is started it's recommended that it is continued without breaks or "vacations". 27 Many individuals are diagnosed only 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 successful are initially recommended after four weeks and once amounts fall below 50copies/mL checks every three to six months are usually 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 very first year. 27

Benefits of treatment include a decreased danger of departure as well as a decreased risk of progression to AIDS. Std test near Nicolaus California. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a reduced danger of transmission to sexual partners of the illness as well as a drop in mom-to-child transmission. 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 intricacy of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 though cost is an important problem with some drugs, 152 47% of people who needed them were taking them in the speed of adherence and low and middle income countries as of 2010 143 is comparable in low-income and high income nations. 153

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