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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 phase 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 generally there are few or no symptoms at first, close to the end of this period a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test closest to Blairsville Georgia. Blairsville, GA 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 tiny proportion (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 individuals who maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent around 1 in 300 contaminated individuals. Blairsville Georgia 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 near Blairsville Georgia, United States. 26 In the absence of specific treatment, around half of individuals 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 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 common cancer occurring in 10 to 20% of individuals 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 who have AIDS. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids as well as 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 people of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this population 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 homosexual and bisexual men have HIV. 49 50 Std test nearby Blairsville.

With regard to unprotected heterosexual contacts, approximations 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 countries 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 particularly 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 danger from receiving oral sex was described as "virtually nil"; 54 nonetheless, a few cases 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 action and male to female transmission as 0.05% per act. 51

The 2nd 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 injections with unsterilized equipment. The danger from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std test nearby GA United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected individual 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 the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some areas more than 80% of individuals 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 acquiring 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 example, in the UK the risk 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 regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test in GA, United States. 11 68 Although rare due to screening, it is possible to acquire HIV from tissue and organ transplantation 69

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HIV can 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 worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in people 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 risk of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment includes the mother administering antiretroviral drugs to the newborn, preventing breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the baby decrease the danger of transmission in those who do breastfeed. 76 Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it may pose a threat of transmission. 71

HIV is a part 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 accountable for long-duration sicknesses with 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 along with the viral genome in the virus particle. The resultant viral DNA is then 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, allowing the virus and its host cell to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, generating viral proteins which are packaged and released from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it applies 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 may also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test nearby Blairsville Georgia. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's continuing replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in 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 reaction is accompanied by a marked drop in the amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell reaction is considered to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to a better prognosis along with slower disease progression, though it doesn't remove the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are critical to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 might also be a variable. During the chronic stage, the results 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

While the symptoms of immune deficiency feature of AIDS do not appear for many years after a person is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body, especially 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 gain access to the cells, whereas merely 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 disease. CD4 T cells in mucosal tissues stay especially affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term phase. 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 several HIV gene products as well as the immune response to ongoing HIV replication. It's also linked to the breakdown 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

Blairsville GA 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 recommended by the United States Preventive Services Task Force for all folks 15years to 65years of age including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many regions of the planet, a third of HIV carriers simply find they're infected at an advanced stage of the disorder when AIDS or severe immunodeficiency is now evident. Std test closest to Blairsville, GA. 27

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Antibody tests in children younger than 18months are normally inaccurate due to the continuing presence of maternal antibodies 102 Consequently 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 dependable PCR testing and lots of areas 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 inhabitants were informed of their HIV status. Blairsville 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 previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related 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 countries. Since the WHO 's staging system does not need laboratory tests, it's suited 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 permit comparison for statistical purposes. 2 24 104

Consistent condom use reduces the risk of HIV transmission by approximately 80% over the long term. 106 When condoms are used by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. 107 There's some evidence to suggest that female condoms may offer an equal degree of protection. Std Test near Blairsville. 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 raise 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, both 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 However, whether it shields against male-to-female transmission is challenged, 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 with men who have sex with men as an option and recommend 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 preventive effects. 119

Programs supporting sexual abstinence don't seem to change subsequent HIV risk. 120 Signs of any advantage from peer education is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A significant minority of young people continues to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test near me GA United States. 123 Voluntary counseling and testing individuals for HIV does not affect dangerous behaviour in individuals 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 effective in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an productive method to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std test near Blairsville Georgia 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 drugs tenofovir , with or without emtricitabine , is powerful 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 with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

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

The World Health Organization and United States advocates antiretrovirals in individuals of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it's advised that it is continued without breaks or "vacations". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is effective are initially advocated after four weeks and once levels fall below 50copies/mL tests every three to six months are typically adequate. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of folks during the very first year. 27

Advantages of treatment include a reduced risk of progression to AIDS and also a reduced risk of departure. Std Test near me Blairsville Georgia. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a decreased risk of transmission to sexual partners of the illness as well as a drop in mother-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 though cost is an important problem with some drugs, 152 47% of those who desired 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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