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The first 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 around three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are few or no symptoms initially, close to the end of this phase a lot 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 more than one group of lymph nodes (other than in the groin) for over three to six months. Std Test in Santa Fe Springs, California. Santa Fe Springs, 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 small percentage (about 5%) keep elevated 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 people who keep a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent about 1 in 300 persons that are infected. Santa Fe Springs, 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 diseases in association with an HIV infection. Std Test nearby Santa Fe Springs California United States. 26 In the lack of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alert 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

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 first indication of AIDS in 3 to 4% and is the cause of death of almost 16% of people with AIDS. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often in those with AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more prevalent 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 majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern 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 specific public accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of gay and bisexual guys have HIV. 49 50 Std test in Santa Fe Springs.

With respect 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 action for female to male transmission, and 0.08% per act for male to female transmission. 51 The risk of transmission from anal intercourse is particularly high, estimated as 1.4-1.7% per action 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 receiving oral sex has been described as "almost 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 has been estimated as 2.4% per act and male to female transmission as 0.05% per action. 51

The second 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 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 in CA, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per act and the danger following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few 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 united kingdom 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 suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these places come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test closest to CA, United States. 11 68 Although rare because of screening, it will be possible 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 way in which HIV is transmitted globally. 11 In the absence of treatment, the risk 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 risk of mother-to-child infection could be reduced to about 1%. 73 Prophylactic treatment involves the mom administering antiretroviral drugs to the newborn, preventing breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the baby decline the danger of transmission in people who do breastfeed. Many of these measures are nevertheless not obtainable in the developing world. 75 If blood contaminates food during pre- chewing it might present 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 responsible for long-duration illnesses with a very long 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 incorporated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once integrated, the virus might become latent, allowing the virus and its particular host cell to avoid detection by the immune system. 83 Instead, the virus might be transcribed, generating new RNA genomes and viral proteins which are packaged and discharged from the cell as new virus particles that begin the replication cycle afresh. 84

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HIV is now known to distribute between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it employs crossed 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 can also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std test nearest Santa Fe Springs California. 86 87 The hybrid distributing mechanics of HIV lead to the continuing replication of the virus against antiretroviral treatments. 85 88

There's 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 response is accompanied by a marked fall in the amount of circulating CD4 T cells. The acute viremia is nearly invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell reaction is believed to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was great was linked to slower disease progression and 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 the immune system weakens and permits opportunistic infections T cells are critical to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 phase, the consequences 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

While the symptoms of immune deficiency characteristic of AIDS don't appear for a long time after a person is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, especially during the first weeks of infection. 95 The reason behind the preferential loss of mucosal CD4 T cells is that nearly all 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 seeks out and destroys CCR5 expressing CD4 T cells during acute illness. 98 A vigorous immune response initiates the clinically latent phase and controls the infection. CD4 T cells in mucosal tissues stay particularly changed. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the long-term period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the action of the immune response and several HIV gene products to HIV replication that is continuing. It's also 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

Santa Fe Springs CA std test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 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 regions of the planet, a third of HIV carriers only discover they're infected at an advanced stage of the disorder when AIDS or severe immunodeficiency is now clear. Std Test nearby Santa Fe Springs, CA. 27

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Antibody evaluations in kids younger than 18months are generally erroneous because of the ongoing presence 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 lots of places simply wait until either symptoms grow 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 people were aware of their HIV status. Santa Fe Springs Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were examined 103 which signified 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 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 often embraced in developed countries. Since the WHO 's staging system doesn't need lab evaluations, it is suited to the resource-restricted conditions encountered in developing countries, where it may also be used to help direct clinical management. Despite their differences, the two systems permit 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's some evidence to suggest that female condoms may offer an equivalent degree of protection. Std Test nearby Santa Fe Springs. 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 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 advocated male circumcision as a method of preventing female to male HIV transmission in areas using a high rates of HIV in 2007. 112 Nonetheless, whether it protects against male to female transmission is questioned, 113 114 and whether it's of benefit in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does that it be discussed as an alternative with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, thereby negating its preventative effects. 119

Plans supporting sexual abstinence don't appear to change subsequent HIV danger. 120 Signs of any gain from peer education is equally poor. 121 Complete sexual education provided at school may fall high risk behavior. 122 A large minority of young people proceeds to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test near CA United States. 123 Voluntary counselling and testing individuals for HIV doesn't affect dangerous behavior in individuals 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 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 infection of their partner (a strategy known as treatment as prevention, or TASP). Std test closest to Santa Fe Springs California, United States. 125 TASP is associated with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir , with or without emtricitabine , is powerful 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 using a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, 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 include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents which include protease inhibitors (PI) are used if the aforementioned 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 "holidays". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is powerful are initially urged after four weeks and once amounts fall below 50copies/mL tests every three to six months are typically adequate. 27 Insufficient 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 very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS as well as a decreased danger of departure. Std Test in Santa Fe Springs, California. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added advantages include a reduced risk of transmission to sexual partners of the illness as well as a decrease in mother-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Motives 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 cost is an important problem with some medicines, 152 47% of those who wanted they were being taken by them in low and middle income nations as of 2010 143 and also the speed of adherence is comparable in low income and high income nations. 153

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