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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second period of the natural history of HIV infection can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms initially, near the end of the stage lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also develop 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 Nepaug Connecticut. Nepaug, CT 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 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 controllers or long-term nonprogressors (LTNP). 31 Another group consists of people who maintain a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 contaminated individuals. Nepaug, 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 infection. Std test nearby Nepaug Connecticut United States. 26 In the absence of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alarm to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

People 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 individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people with AIDS and is the initial sign of AIDS in 3 to 4%. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more frequently 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 portion 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 worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this specific people 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 Nepaug.

With regard to unprotected heterosexual contacts, approximations of the danger 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 action; 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 particularly 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 comparatively low, it is still present. 53 The danger from receiving oral sex was described as "virtually nil"; 54 yet, a couple instances 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 frequent 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 threat from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test near CT, United States. 63 The danger of acquiring 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 USA intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in certain places more than 80% of individuals 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 very low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for example, 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 CT United States. 11 68 Although rare because of screening, it really is 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 resulting in infection in the baby. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the lack of treatment, the danger 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 proper treatment the risk of mother-to-child infection may be reduced to about 1%. 73 Prophylactic 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 baby decline the danger of transmission in those who do breastfeed. Many of these measures are however not available in the developing world. 75 If blood contaminates food during pre- it might introduce 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 responsible for long-duration sicknesses using 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's transported along with the viral genome in the virus particle. The resulting viral DNA is then 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 may become latent, allowing its host cell and the virus to avoid detection by the immune system. 83 Instead, the virus might 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 afresh. 84

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HIV is now known to disperse between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it uses crossed spreading mechanics. 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 Nepaug Connecticut. 86 87 The hybrid dispersing mechanisms of HIV contribute to the on-going replication of the virus against antiretroviral therapies. 85 88

There's 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 degree 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 always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell reaction is considered to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been linked to a better prognosis along with slower disease progression, though it does not get rid of the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight illnesses or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 might also be a variable. During the chronic period, the results of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decline in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency feature of AIDS do not appear for decades after a person is infected, the majority of CD4 T cell loss happens during the very first weeks of infection, 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 access the cells, whereas only a tiny 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 infection and seeks out. 98 A vigorous immune response initiates the latent stage and controls the infection. CD4 T cells in mucosal tissues remain especially changed. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term period. 99 Immune activation, which is represented 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 HIV replication that is continuing. It is also 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

Nepaug 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 advised by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Additionally, testing is suggested for those at high risk, which includes anyone. 27 In many regions of the planet, a third of HIV carriers simply discover when AIDS or acute immunodeficiency has become apparent, they are infected at an advanced stage of the disease. Std Test nearby Nepaug CT. 27

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Antibody evaluations in kids younger than 18months are typically erroneous due to the ongoing 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 trusted PCR testing and many places just wait until either symptoms develop or the kid is old enough for exact antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Nepaug Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 103 which represented a considerable increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-associated disorder 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 embraced in developed nations. Since the WHO 's staging system doesn't need laboratory evaluations, it's satisfied to the resource-restricted states encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems enable comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used consistently 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 provide an equal degree of protection. Std Test in Nepaug. 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 because of its inclination to cause vaginal and rectal 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 advocated male circumcision as a method of preventing female to male HIV transmission in 2007 in regions using a high rates of HIV. 112 Yet, whether it protects against male to female transmission is contested, 113 114 and whether it is of advantage in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does advocate for all sexually active heterosexual males and that it be discussed with men who have sex with men as an option. 118 Some experts fear that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behaviour, thus negating its preventive effects. 119

Plans supporting sexual abstinence don't appear to change subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally poor. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A considerable minority of young people proceeds to participate in high risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearby CT United States. 123 Voluntary counselling and testing people for HIV will not influence hazardous behaviour in those who test negative but does increase condom use in those who test positive. 124 It is not known whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is a very effective method to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test closest to Nepaug Connecticut United States. 125 TASP is connected with 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 successful in a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It may also be effective in intravenous drug users using a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are blends (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially therapy 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 Mixtures of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in people of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 Once treatment is started it's advised that it is continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is powerful are initially advocated after four weeks and once levels fall below 50copies/mL tests every three to six months are usually sufficient. 27 Insufficient 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

Benefits of treatment include a decreased risk of progression to AIDS and also a reduced risk of departure. Std test near Nepaug, Connecticut. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a decreased danger of transmission to sexual partners of the disease and also a drop in mother-to-child transmission. 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 Even though cost is an important issue with some drugs, 152 47% of people who needed them were taking them in the speed of adherence as well as middle and low income countries as of 2010 143 is similar in low-income and high-income countries. 153

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