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The initial symptoms are followed by a period called asymptomatic HIV, clinical latency, or continual HIV. 1 Without treatment, this second stage of the natural history of HIV infection 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 at first, near the end of the stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , defined 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 nearest Verdugo City, California. Verdugo City, 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 tiny percentage (about 5%) retain elevated rates of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV accountants or long-term nonprogressors (LTNP). 31 Another group consists of those who keep a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 persons that are contaminated. Verdugo 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 incidence of specific diseases in association with an HIV infection. Std test closest to Verdugo City 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 alert to the existence 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 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 typical cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the initial sign of AIDS in 3 to 4% and is the cause of death of nearly 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 inner part of eyelids and also 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 individual. 11 The majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in the USA 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. While 28 percent of transgender women test positive 49 About 15% of homosexual and bisexual men have HIV. 49 50 Std Test closest to Verdugo City.

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 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 action; the equivalent approximations for high income states 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 comparatively low, it is still present. 53 The risk from receiving oral sex was described as "almost nil"; 54 nevertheless, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 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 next most common way 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 injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test nearby CA United States. 63 The risk 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 hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few areas 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 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 UK the hazard 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 in CA, United States. 11 68 Although rare due to screening, it really is likely to acquire 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 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 those 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 Preventative treatment involves the mother preventing breastfeeding, taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the danger of transmission in those who do breastfeed. Many of these measures are yet not available in the developing world. 75 If blood contaminates food during pre- chewing it might present a danger 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 accountable for 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 (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported together with the viral genome in the virus particle. The resultant viral DNA is subsequently 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 may become latent, enabling its host cell and the virus to avoid detection by the immune system. 83 Instead, the virus may be transcribed, creating viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle over and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel routes: cell free spread and cell-to-cell spread, i.e. it uses 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 can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test nearby Verdugo City California. 86 87 The hybrid dispersing mechanics of HIV contribute to the on-going replication of the virus against antiretroviral treatments. 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 amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable drop in the amount of circulating CD4 T cells. The acute viremia is almost invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell reaction is considered to be important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good has been linked to slower disease progression and a better prognosis, though it does not remove the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are essential 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 variable. During the chronic stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells seem to account for the slow decline in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4 T cell loss occurs during the first weeks of infection, especially in the intestinal mucosa, which harbors most of the lymphocytes found within the body. 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 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 illness. 98 A vigorous immune response starts the latent phase and eventually controls the infection. CD4 T cells in mucosal tissues stay especially impacted. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the chronic stage. 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 as well as several HIV gene products to HIV replication that is ongoing. It's 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

Verdugo City, CA std test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of certain signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone. 27 In many regions of the planet, a third of HIV carriers only discover when AIDS or acute immunodeficiency has become obvious, they are infected at an advanced stage of the disorder. Std Test nearby Verdugo City, CA. 27

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Antibody tests in kids younger than 18months are typically inaccurate because of the continued existence 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 dependable PCR testing and a lot of places just wait the child is old enough for antibody testing that is accurate or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. Verdugo City std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were tested 103 which signified a significant increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated disease for surveillance purposes: the WHO disease staging system for HIV infection and disease , 24 as well as 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 doesn't need laboratory tests, it is suited to the resource-restricted conditions encountered in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems enable comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger 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 speed of HIV infection is less than 1% per year. 107 There is some evidence to suggest that female condoms may offer an equivalent level of protection. Std test in Verdugo 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 rectal and vaginal 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 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 questioned, 113 114 and whether it is of benefit in developed nations 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 as an option with men who have sex with men. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, thereby negating its prophylactic effects. 119

Programs supporting sexual abstinence do not appear to change subsequent HIV risk. 120 Signs of any gain from peer education is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A large minority of young people continues to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std test near CA United States. 123 Voluntary counselling and testing people for HIV doesn't affect dangerous behavior in individuals 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 successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is a very productive method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test near me Verdugo City 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 successful 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 using a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are mixes (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes," of antiretroviral agents. 144 Initially therapy is typically 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 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 After treatment is started it's advised that it's continued without breaks or "holidays". 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 advocated after four weeks and once degrees drop below 50copies/mL tests every three to six months are usually adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of folks during the first year. 27

Benefits of treatment include a reduced risk of progression to AIDS and a reduced danger of departure. Std test closest to Verdugo City California. 147 In the developing world treatment also improves mental and physical health. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a decreased risk of transmission of the illness to sexual partners and also a reduction in mother-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Reasons 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 issue with some medicines, 152 47% of those who needed they were being taken by them in middle and low income nations as of 2010 143 as well as the rate of adherence is similar in low income and high-income states. 153

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