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The first symptoms are followed by a stage called persistent HIV, asymptomatic HIV, or clinical latency. 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 at first, close to the end of this phase lots of people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also grow 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 near Alma, Colorado. Alma, CO 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 high 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 individuals who maintain a low or undetectable viral load without anti-retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 individuals that are contaminated. Alma, Colorado 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 infection. Std test near me Alma Colorado United States. 26 In the absence of specific treatment, around half of people 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 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the first sign of AIDS in 3 to 4% and is the cause of death of nearly 16% of people 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 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 person. 11 The majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, the routine 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 people 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 guys have HIV. 49 50 Std Test in Alma.

With respect to unprotected heterosexual contacts, estimates 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 countries. 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 estimates for high-income states are 0.04% per action for female-to-male transmission, and 0.08% per act for male to female transmission. 51 The danger of transmission from anal intercourse is particularly 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 receiving oral sex has been described as "almost nil"; 54 however, a few instances have been 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 action. 51

The next 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 contaminated 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 CO United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to contaminated 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 certain places 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 getting 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 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 suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these places come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std Test nearest CO, United States. 11 68 Although rare because of screening, it will be likely to acquire 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 causing infection in the infant. 73 74 This is the third most common manner in which HIV is transmitted internationally. 11 In the absence of treatment, the danger of transmission before or during birth is around 20% and in those who also 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 could be reduced to about 1%. 73 Preventive treatment involves the mother averting 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 decrease the risk of transmission in those who do breastfeed. Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- it might present a risk 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 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 is 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 integrated, the virus might become latent, allowing its own host cell and the virus to avoid detection by the immune system. 83 Instead, the virus could be transcribed, creating new RNA genomes and viral proteins which are packaged and discharged from the cell as new virus particles that begin the replication cycle anew. 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 spreading mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid after which infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std test near Alma Colorado. 86 87 The hybrid spreading mechanics of HIV lead to the virus's continuing replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, leading to an abundance 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 drop in the amount of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell response is thought to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it does not eliminate the virus a great CD8 T cell response was linked to slower disease progression as well as a better prognosis. 92

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

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for many years after someone is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found in the body, particularly during the first weeks of infection. 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 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 disease and seeks out. 98 A vigorous immune response eventually controls the infection and starts the latent stage. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the chronic period. 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 several HIV gene products and also the immune response to HIV replication that is continuing. Additionally it is 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

Alma CO Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of particular signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Also, testing is suggested for those at high risk, which comprises anyone. 27 In many regions of the world, a third of HIV carriers just find they're infected at an advanced stage of the disease when severe immunodeficiency or AIDS has become apparent. Std test closest to Alma CO. 27

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Antibody evaluations in kids younger than 18months are typically inaccurate because of the continuing presence of maternal antibodies 102 So 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 reliable PCR testing and many areas just wait the kid is old enough for precise 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. Alma Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which signified a considerable increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related ailment for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 and the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently embraced in developed nations. Since the WHO 's staging system does not require laboratory evaluations, it is satisfied to the resource-restricted states encountered in developing countries, where it can be utilized to help guide clinical management. Despite their differences, the two systems allow 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 by a couple in which one individual is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equal level of protection. Std Test closest to Alma. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce 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 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 the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female to male HIV transmission in areas with a high rates of HIV in 2007. 112 Nonetheless, whether it shields against male-to-female transmission is disputed, 113 114 and whether it's 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 option and advocate for all sexually active heterosexual males. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, hence negating its prophylactic effects. 119

Plans encouraging sexual abstinence don't appear to change subsequent HIV danger. 120 Signs of any gain from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A significant minority of young people proceeds to engage in high risk practices despite knowing about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test closest to CO United States. 123 Voluntary counselling and testing people for HIV does not affect dangerous behavior in those who test negative but does raise 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 quite an effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearest Alma Colorado, United States. 125 TASP is related to a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications tenofovir , with or without emtricitabine , is successful in several 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 decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," 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 contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Mixtures of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it is advised that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have begun. 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 advocated after four weeks and once amounts fall below 50copies/mL checks 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 effective in more than 95% of people during the first year. 27

Benefits of treatment include a decreased risk of progression to AIDS as well as a decreased danger of departure. Std Test nearest Alma Colorado. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased risk of transmission to sexual partners of the disease and a drop in mom-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Reasons for non-adherence include poor access to medical care, 149 inadequate 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 price is an important problem with some drugs, 152 47% of those who desired they were being taken by them in the rate of adherence and also middle and low income nations as of 2010 143 is comparable in low income and high income countries. 153

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