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The initial symptoms are followed by a period called asymptomatic HIV clinical latency, or chronic 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 no or few symptoms in the beginning, close to the end of the stage lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow 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 nearest Dacono Colorado. Dacono, CO std test. 2

Although most HIV 1 infected people have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a tiny proportion (about 5%) retain high levels 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 about 1 in 300 contaminated persons. Dacono, 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 disease. Std test near me Dacono Colorado United States. 26 In the absence of special treatment, around half of people 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

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, which is the cause of death of nearly 16% of people who have AIDS and is the initial signal of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often in those with AIDS due to 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 frequent mode of transmission of HIV is through sexual contact with an infected person. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, 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 guys, with this specific 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 gay and bisexual men have HIV. 49 50 Std Test in Dacono.

With regard 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 states. 51 In low income countries, 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 countries are 0.04% per act for female to male transmission, and 0.08% per action 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 danger of transmission from oral sex is relatively low, it's still present. 53 The risk from getting oral sex has been described as "virtually nil"; 54 yet, a few instances 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 next most common 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 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 nearest CO United States. 63 The danger of getting HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the risk following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in a few places more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed countries 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 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's estimated that up to 15% of HIV infections in these regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std test nearby CO United States. 11 68 Although rare due to screening, it really is possible to get HIV from organ and tissue transplantation 69

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HIV could 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 manner in which HIV is transmitted worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals 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 Preventative treatment includes the mom administering antiretroviral drugs to the newborn, avoiding breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed. Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it might pose 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically in charge of long-duration sicknesses 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting 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 integrated, the virus might become latent, allowing the virus and its host cell to prevent detection by the immune system. 83 Instead, the virus may be transcribed, creating new RNA genomes and viral proteins which are packaged and released 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 mechanics. 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 process of cell-to-cell spread. Std test closest to Dacono Colorado. 86 87 The hybrid dispersing mechanics of HIV lead to the ongoing replication of the virus against antiretroviral treatments. 85 88

After the virus enters the body there's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. 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 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 subsequently with antibody generation, or seroconversion The CD8 T cell reaction is thought to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it will not remove the virus a good CD8 T cell response was associated with slower disease progression and also a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are critical to the immune response and without them, the body cannot fight diseases 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 may also be a variable. During the chronic stage, the consequences 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 don't appear for years after a person is infected, the majority of CD4 T cell loss happens during the first weeks of disease, particularly 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 most mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas just 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 destroys CCR5 expressing CD4 T cells during acute disease and seeks out. 98 A vigorous immune response starts the clinically latent phase and controls the disease. CD4 T cells in mucosal tissues remain especially affected. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the long-term 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 and also several HIV gene products to ongoing HIV replication. It is also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Dacono, CO Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Moreover, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers only find they're infected at an advanced phase of the disorder when severe immunodeficiency or AIDS is now evident. Std test near Dacono CO. 27

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Antibody evaluations in kids younger than 18months are normally inaccurate due to the continuing presence of maternal antibodies 102 Hence 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 places just wait the child is old enough for exact antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Dacono Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were analyzed 103 which signified a substantial increase compared to preceding years. 103

Two chief 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 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 lab tests, it's suited to the resource-restricted conditions encountered in developing countries, where it can also be used to help guide 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 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 imply that female condoms may offer an equivalent degree of protection. Std test in Dacono. 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 raise the risk of transmission because of its propensity 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female to male HIV transmission in 2007 in areas with a high rates of HIV. 112 Nonetheless, whether it protects against male-to-female transmission is challenged, 113 114 and whether it's of advantage in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, nevertheless, does that it be discussed with men who have sex with men as an alternative and advocate 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 preventive effects. 119

Plans encouraging sexual abstinence do not appear to influence subsequent HIV risk. 120 Signs of any benefit from peer education is equally poor. 121 Complete sexual education provided at school may decrease high risk behaviour. 122 A considerable minority of young people proceeds to engage in high risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std test in CO, United States. 123 Voluntary counselling and testing people for HIV does not influence dangerous behaviour 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 quite an productive way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test in Dacono Colorado, United States. 125 TASP is related to a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the drugs 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 young 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 alternatives are mixes (or "cocktails") consisting of at least three medications 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 contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in people of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is started it is advised that it's continued without breaks or "vacations". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desirable results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is successful are initially urged after four weeks and once amounts fall below 50copies/mL checks every three to six months are generally sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is effective in more than 95% of individuals during the first year. 27

Advantages of treatment contain a reduced risk of departure and a reduced risk of progression to AIDS. Std Test closest to Dacono Colorado. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a reduced risk of transmission to sexual partners of the disease as well as a drop in mother-to-child transmission. 144 The effectiveness of treatment depends to a large part on conformity. 27 Rationales 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 countries as of 2010 143 and also the speed of adherence is comparable in low income and high-income nations. 153

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