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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second stage 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 commonly there are few or no symptoms in the beginning, near the end of this period lots of people experience weight loss, fever, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also develop persistent generalized lymphadenopathy , characterized 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 near me Penn Valley California. Penn Valley CA Std Test. 2

Although most HIV-1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) retain high amounts 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 "elite suppressors". They represent around 1 in 300 persons that are infected. Penn 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 occurrence of specific diseases in association with an HIV disease. Std Test nearby Penn Valley 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 common initial conditions that alarm to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the type 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 first signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of people with AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more frequently in those with AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and also 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 individual. 11 The majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among states. 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 gay and bisexual guys have HIV. 49 50 Std test near Penn Valley.

With respect to unprotected heterosexual contacts, estimates 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 nations. 51 In low-income countries, the risk 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 approximations 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 especially high, estimated as 1.4-1.7% per action in both heterosexual and homosexual contacts. 51 52 While the danger 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 nevertheless, a few cases 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 was 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 infected blood or blood product, or medical injections with unsterilized equipment. The danger from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test near me 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 threat following mucous membrane exposure to infected 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 regions 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 very low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for example, in the UK 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 regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test nearest CA United States. 11 68 Although rare due to screening, it is possible to get HIV from organ and tissue transplantation 69

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HIV may 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 worldwide. 11 In the absence of treatment, the danger of transmission before or during birth is around 20% and in those who additionally 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 could be reduced to about 1%. 73 Preventative 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 decrease the danger of transmission in those who do breastfeed. 76 Many of these measures are nevertheless not accessible the developing world. 75 If food is contaminated by blood during pre- it may introduce a danger 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 accountable for long-duration illnesses with an extended 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 (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 then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus might become latent, allowing the virus and its host cell to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, producing viral proteins which are packaged and released from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it uses crossed propagating mechanics. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and 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 Penn Valley, California. 86 87 The hybrid distributing mechanics 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 level of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked fall in the amount of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards 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. A good CD8 T cell response was associated with slower disease progression and a better prognosis, though it does not remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This permits 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 chronic 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 phase, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells seem to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency feature of AIDS don't appear for years after an individual is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body, particularly during the very 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 access the cells, whereas merely a small 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. The disease is eventually controlled by 98 A vigorous immune response and starts the clinically latent phase. CD4 T cells in mucosal tissues stay especially affected. 98 Continuous HIV replication causes a state of generalized immune activation prevailing 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 also several HIV gene products to ongoing HIV replication. It is 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

Penn Valley, 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 folks 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many sections of the world, a third of HIV carriers simply discover when severe immunodeficiency or AIDS is now evident they are infected at an advanced stage of the disorder. Std test nearby Penn Valley CA. 27

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Antibody evaluations in children younger than 18months are commonly wrong due to the continued existence of maternal antibodies 102 Hence 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 a lot of areas simply wait until either symptoms develop or the kid is old enough for antibody testing that is exact. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Penn Valley std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a considerable increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related ailment 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 often adopted in developed countries. Since the WHO 's staging system does not need laboratory evaluations, it is suited to the resource-controlled states encountered in developing countries, where it can also be used to help direct clinical management. Despite their differences, the two systems enable 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 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 provide an equal level of protection. Std Test in Penn Valley. 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 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 the World Health Organization and UNAIDS advocated male circumcision as a way of preventing female-to-male HIV transmission in 2007 in regions with a high rates of HIV. 112 Nevertheless, whether it shields against male to female transmission is disputed, 113 114 and whether it is of benefit in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does that it be discussed with men who have sex with men as an alternative and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk-taking behaviour, hence negating its prophylactic effects. 119

Programs supporting sexual abstinence do not seem to impact subsequent HIV risk. 120 Evidence of any advantage from peer education is equally inferior. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A substantial 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 counselling and testing individuals for HIV does not affect dangerous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It isn't known 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 disease of their partner (a strategy known as treatment as prevention, or TASP). Std Test near Penn Valley California, United States. 125 TASP is connected 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 youthful heterosexuals in Africa. 109 It can also be effective in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixes (or "cocktails") consisting of at least three medications belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: 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 mentioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in people 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's advised that it is continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desirable results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is effective are initially recommended after four weeks and once amounts drop below 50copies/mL tests every three to six months are usually sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of people during the very first year. 27

Benefits of treatment include a decreased danger of death as well as a decreased risk of progression to AIDS. Std Test in Penn Valley California. Mental and physical health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a reduced risk of transmission to sexual partners of the illness as well as a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Rationales 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 issue with some medicines, 152 47% of those who desired they were being taken by them in the speed of adherence and also middle and low income nations as of 2010 143 is similar in low-income and high-income countries. 153

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