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The initial symptoms are followed by a period called clinical latency, asymptomatic HIV, or chronic HIV. 1 Without treatment, this second period of the natural history of HIV disease can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are no or few symptoms initially, near the end of the phase lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals 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 me Stevenson, Connecticut. Stevenson, 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 percentage (about 5%) keep 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 controllers or long term nonprogressors (LTNP). 31 Another group consists of people 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 persons that are contaminated. Stevenson 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 diseases in association with an HIV infection. Std Test in Stevenson Connecticut, United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring first 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 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 typical cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of almost 16% of people with AIDS and is the first indication of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often 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 as well as the white portion 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 person. 11 The bulk 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 states. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this particular 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 guys have HIV. 49 50 Std test near me Stevenson.

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 countries. 51 In low income nations, the threat 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 states 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 particularly high, estimated as 1.4-1.7% per act in both heterosexual and homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it is still present. 53 The danger from getting oral sex has been described as "nearly nil"; 54 nevertheless, a couple 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 has been estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The second 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 contaminated blood or blood product, or medical shots with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test closest to 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 danger following mucous membrane exposure to infected 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 appropriately screened (as of 2008), 67 and it is 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 diseases. Std test closest to CT United States. 11 68 Although rare due to screening, it 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 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 risk of transmission before or during birth is around 20% and in people who additionally breastfeed 35%. 73 As of 2008, perpendicular 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 Preventative treatment includes the mother 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 infant decrease the danger of transmission in people who do breastfeed. 76 Many of these measures are yet not available in the developing world. 75 If blood contaminates food during pre- chewing it might introduce a threat 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 in charge of long-duration sicknesses using 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 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 afresh. 84

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HIV is now understood to spread between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it uses crossed propagating 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 can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std test in Stevenson, Connecticut. 86 87 The hybrid spreading mechanisms of HIV contribute to the virus's on-going replication against antiretroviral treatments. 85 88

After the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked fall in the number of circulating CD4 T cells. The acute viremia is nearly always related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell reaction is believed to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to slower disease progression and also a better prognosis, 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 essential 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 acute and long-term 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 factor. 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 appear to account for the slow decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS do not appear for years after an individual is infected, the bulk of CD4 T cell loss happens during the first weeks of infection, particularly in the intestinal mucosa, which harbors most of the lymphocytes found in the body. 95 The reason behind 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 just a little 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 illness and seeks out. 98 A vigorous immune response initiates the latent period and eventually controls the infection. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the chronic phase. 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 as well as the immune response to HIV replication that is ongoing. 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

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

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Antibody tests in kids younger than 18months are commonly inaccurate due to the continued presence of maternal antibodies 102 Consequently 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 trusted PCR testing and lots of places just wait until either symptoms develop or the kid is old enough for accurate antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Stevenson std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a significant increase compared to previous 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 along with 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 doesn't need laboratory evaluations, it is suited to the resource-controlled conditions seen in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems permit comparison for statistical purposes. 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 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 equal degree of protection. Std test nearest Stevenson. 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 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female-to-male HIV transmission in 2007 in regions with a high rates of HIV. 112 Yet, whether it protects against male to female transmission is questioned, 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 recommend for all sexually active heterosexual males and that it be discussed as an alternative 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 preventative effects. 119

Programs encouraging sexual abstinence do not seem to affect subsequent HIV risk. 120 Evidence of any advantage from peer education is equally inferior. 121 Comprehensive sexual education provided at school may fall high risk behavior. 122 A sizeable minority of young people proceeds to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test in CT United States. 123 Voluntary counseling and testing individuals for HIV does not change risky behavior 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 successful in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is a very productive way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Stevenson Connecticut, 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 effective 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 with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

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

The World Health Organization and United States recommends antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it's recommended that it is continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desired result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is effective are initially advocated after four weeks and once levels drop below 50copies/mL checks every three to six months are typically sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of people during the very first year. 27

Benefits of treatment include a decreased risk of death and also a reduced risk of progression to AIDS. Std Test nearby Stevenson, Connecticut. Physical and mental health also enhances. 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 also a decrease in mom-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 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 though price is an important problem with some medicines, 152 47% of those who desired they were being taken by them in low and middle income countries as of 2010 143 and the rate of adherence is similar in low-income and high income nations. 153

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