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The initial symptoms are followed by a stage called asymptomatic HIV clinical latency, or chronic HIV. 1 Without treatment, this second period 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 usually there are few or no symptoms at first, near the end of the period lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , defined 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 me Cromwell, Connecticut. Cromwell, CT 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 little proportion (about 5%) keep elevated amounts 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 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 individuals that are infected. Cromwell Connecticut 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 disorders in association with an HIV disease. Std Test near me Cromwell Connecticut, United States. 26 In the absence of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alarm to the existence 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 an increased 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, which is the cause of death of nearly 16% of individuals with AIDS and is the initial signal of AIDS in 3 to 4%. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior 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 frequent mode of transmission of HIV is through sexual contact with an infected person. 11 The bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern 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 particular 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 guys have HIV. 49 50 Std Test in Cromwell.

With respect to unprotected heterosexual contacts, approximations of the risk 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 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 states are 0.04% per act for female-to-male transmission, and 0.08% per act for male to female transmission. 51 The danger of transmission from anal intercourse is especially 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 comparatively low, it is still present. 53 The risk from receiving oral sex has been described as "nearly nil"; 54 nevertheless, a couple instances are 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 second 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 shots 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 in CT, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per act and the danger following mucous membrane exposure to contaminated 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 some regions 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 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 threat 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 places come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std Test closest to CT, United States. 11 68 Although rare because of screening, it will be possible to get HIV from tissue and organ transplantation 69

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HIV may 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 internationally. 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, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment involves the mother avoiding breastfeeding taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the baby decrease the danger of transmission in people who do breastfeed. Many of these measures are nevertheless not available in the developing world. 75 If food is contaminated by blood during pre- chewing it might pose a risk 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 sicknesses using a lengthy 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's transported together with the viral genome in the virus particle. The consequent viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus might become latent, enabling the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating new RNA genomes and viral proteins which are packaged and discharged from the cell as new virus particles that start the replication cycle afresh. 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 employs crossed propagating mechanisms. 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 may also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test near me Cromwell, Connecticut. 86 87 The hybrid distributing 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 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 drop in the number of circulating CD4 T cells. The acute viremia is nearly invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody production, or seroconversion The CD8 T cell response is considered to be significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good was linked to slower disease progression along with a better prognosis, though it doesn't 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 essential 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 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 might also be a variable. During the chronic period, 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

Although the symptoms of immune deficiency feature of AIDS don't appear for years after an individual is infected, the majority of CD4 T cell loss happens during the first weeks of illness, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body. 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 obtain access to the cells, whereas just a tiny 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 begins the latent phase and controls the infection. CD4 T cells in mucosal tissues stay especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the chronic stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of the immune response and several HIV gene products to HIV replication that is continuing. Additionally it is 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

Cromwell, CT Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone. 27 In many sections of the world, a third of HIV carriers just find when severe immunodeficiency or AIDS is now apparent, they are infected at an advanced period of the disorder. Std test in Cromwell CT. 27

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Antibody evaluations in kids younger than 18months are usually inaccurate due to the continued presence of maternal antibodies 102 Hence 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 lots of places simply wait until either symptoms grow or the kid is old enough for antibody testing that is precise. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Cromwell std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were analyzed 103 which signified a considerable increase compared to preceding years. 103

Two primary 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 as well as the CDC classification system for HIV infection 104 The CDC 's classification system is more often adopted in developed nations. Since the WHO 's staging system does not need laboratory evaluations, it's satisfied to the resource-controlled conditions seen in developing countries, where it can also be utilized 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 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's some evidence to imply that female condoms may offer an equivalent degree of protection. Std Test nearest Cromwell. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase 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 the World Health Organization and UNAIDS recommended male circumcision as a way 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 contested, 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, nevertheless, does that it be discussed as an option with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower perception of exposure among circumcised men may cause more sexual risk taking behavior, thereby negating its preventative effects. 119

Programs encouraging sexual abstinence don't seem to impact subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally poor. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A large minority of young people proceeds to participate in high risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearby CT United States. 123 Voluntary counseling and testing people for HIV will not affect high-risk behaviour in individuals who test negative but does increase condom use in individuals who test positive. 124 It isn't 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 a very productive method to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std test nearest Cromwell Connecticut 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 effective in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It can also be successful in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," 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 Combinations of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in people of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 Once treatment is started it is recommended that it's continued without breaks or "vacations". 27 Many people are diagnosed only 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 determine if treatment is powerful are initially recommended after four weeks and once amounts drop below 50copies/mL tests every three to six months are typically 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 individuals during the very first year. 27

Advantages of treatment contain a reduced risk of departure as well as a reduced risk of progression to AIDS. Std test nearest Cromwell Connecticut. 147 In the developing world treatment also enhances physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased risk of transmission to sexual partners of the disease and a reduction in mom-to-child transmission. The effectiveness of treatment depends to a large part on conformity. 27 Rationales for non-adherence include poor access to medical care, 149 insufficient 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 Even though cost is an important problem with some drugs, 152 47% of people who wanted they were being taken by them in the rate of adherence and low and middle income nations as of 2010 143 is comparable in low-income and high income nations. 153

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