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The first symptoms are followed by a period called asymptomatic HIV, clinical latency, or persistent HIV. 1 Without treatment, this second stage 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 typically there are few or no symptoms initially, close to the end of this period a lot of people experience gastrointestinal difficulties, weight loss, fever 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 crotch) for over three to six months. Std Test nearby Suisun City, California. Suisun City, 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 little proportion (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 those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 individuals that are infected. Suisun City, 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 infection. Std Test closest to Suisun City California United States. 26 In the absence of particular 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 kind of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have an increased 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the initial indication 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 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 and the white part 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 pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this 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 homosexual and bisexual guys have HIV. 49 50 Std test nearest Suisun City.

With respect to unprotected heterosexual contacts, approximations 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 nations. 51 In low-income countries, the danger of female-to-male transmission is estimated as 0.38% per action, and of male to female transmission as 0.30% per act; the equivalent estimates for high income countries are 0.04% per act for female to male transmission, and 0.08% per act for male-to-female transmission. 51 The risk of transmission from anal intercourse is especially 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's still present. 53 The risk from getting oral sex was described as "nearly nil"; 54 however, 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 act and male to female transmission as 0.05% per act. 51

The 2nd most common way 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 threat from sharing a needle during drug shot 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 acquiring 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 infected blood as 0.09% (about 1 in 1000) per action. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the risk 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 instance, in the united kingdom 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 suitably screened (as of 2008), 67 and it's 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 nearby CA, United States. 11 68 Although rare due to screening, it really is likely to get HIV from tissue and organ transplantation 69

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HIV could 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 individuals who additionally breastfeed 35%. 73 As of 2008, perpendicular 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 Preventative treatment involves the mother administering antiretroviral drugs to the newborn, averting 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 risk of transmission in people who do breastfeed. 76 Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it may present a threat 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 in charge of long-duration illnesses with a very 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 (reverse 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 subsequently 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 might become latent, allowing the virus and its own host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating viral proteins which are packaged and discharged 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 known to distribute between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it uses crossed propagating mechanisms. 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 closest to Suisun City, California. 86 87 The hybrid spreading 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 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 reaction is accompanied by a noticeable drop in the amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell reaction is considered to be significant 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 as well as a better prognosis, though it doesn't remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are crucial to the immune response and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and long-term 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 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS do not appear for decades after someone 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, especially during the first weeks of infection. 95 The reason for 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 access the cells, whereas merely a little 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 starts the latent phase and controls the infection. CD4 T cells in mucosal tissues stay particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the chronic period. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products and also the immune response to HIV replication that is ongoing. Additionally it is linked to the dysfunction 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

Suisun City, CA Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence of particular signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Additionally, testing is suggested for those at high risk, which includes anyone. 27 In many sections of the world, a third of HIV carriers only discover when acute immunodeficiency or AIDS has become apparent, they're infected at an advanced phase of the disease. Std Test nearby Suisun City, CA. 27

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Antibody evaluations in children younger than 18months are commonly inaccurate because of the ongoing presence of maternal antibodies 102 So 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 places just wait the kid is old enough for accurate antibody testing or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Suisun City Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were examined 103 which represented a substantial increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance purposes: 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 embraced in developed nations. Since the WHO 's staging system doesn't need lab tests, it is suited to the resource-restricted conditions seen in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems enable comparison for statistical functions. 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 offer an equal degree of protection. Std test nearby Suisun City. 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 inclination 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, both UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female-to-male HIV transmission in 2007 in areas using a high rates of HIV. 112 Nevertheless, whether it protects against male-to-female transmission is challenged, 113 114 and whether it is of advantage 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 option with men who have sex with men and recommend for all sexually active heterosexual males. 118 Some experts fear that a lower understanding of vulnerability among circumcised men may cause more sexual risk-taking behaviour, hence negating its preventative effects. 119

Programs supporting sexual abstinence don't appear to influence subsequent HIV danger. 120 Evidence of any benefit from peer education is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A large minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std Test nearby CA, United States. 123 Voluntary counselling and testing individuals for HIV will not affect high-risk behaviour in those who test negative but does increase condom use in individuals who test positive. 124 It is not 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 a very productive method to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test near me Suisun City 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 might also be successful in intravenous drug users with a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially treatment is generally a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents including protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

United States and the World Health Organization advocates antiretrovirals in people of all ages including pregnant women as soon as the analysis 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 result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is successful are initially recommended after four weeks and once degrees drop below 50copies/mL checks every three to six months are typically adequate. 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 very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS and a decreased risk of death. Std test in Suisun City, 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 Added benefits include a decreased danger of transmission to sexual partners of the illness and also a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable 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 though cost is an important problem with some medications, 152 47% of those who needed them were taking them in middle and low income nations as of 2010 143 and also the rate of adherence is comparable in low income and high income states. 153

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