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The first symptoms are followed by a stage called chronic HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV infection can continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms at first, close to the end of this phase a lot of people experience gastrointestinal problems, weight loss, fever 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 crotch) for over three to six months. Std test near Culloden, Georgia. Culloden, GA 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 small percentage (about 5%) retain 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 "elite suppressors". They represent around 1 in 300 contaminated individuals. Culloden, 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 disorders in association with an HIV disease. Std Test in Culloden Georgia United States. 26 In the lack of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alert to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the kind 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, which is the cause of death of almost 16% of people who have AIDS and is the first hint 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 interior part of eyelids and the white part of the eye) is also more common 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 however, the routine of transmission varies significantly among states. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this public accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of homosexual and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test near Culloden.

With respect to unprotected heterosexual contacts, approximations of the danger of HIV transmission per sexual act appear 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 act, and of male-to-female transmission as 0.30% per act; the equivalent approximations 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 gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from getting oral sex has been described as "virtually nil"; 54 nonetheless, a couple cases 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 has been estimated as 2.4% per action and male to female transmission as 0.05% per action. 51

The 2nd 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 contaminated blood or blood product, or medical injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test near me GA United States. 63 The risk of getting 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 act. 47 In the United States 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 infected blood. 63 In developed nations the danger 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 example, in the UK the danger 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 areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std test near me GA United States. 11 68 Although rare because of screening, it really is likely to acquire HIV from organ and tissue transplantation 69

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HIV may 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 way in which HIV is transmitted worldwide. 11 In the absence 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 danger of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment involves the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decrease the danger of transmission in those who do breastfeed. Many of these measures are yet not obtainable in the developing world. 75 If blood contaminates food during pre- chewing it may present a danger 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 responsible for long-duration illnesses with 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 is transported along with the viral genome in the virus particle. The resultant 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 incorporated, the virus may become latent, allowing its own host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, creating new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that start 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 applies hybrid propagating 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 in Culloden Georgia. 86 87 The hybrid dispersing mechanisms of HIV contribute 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 degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked fall in the amount of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is considered to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was great was associated with slower disease progression and a better prognosis, though it will not get rid of the virus. 92

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Finally, 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 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 stage, the effects 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

While the symptoms of immune deficiency feature of AIDS don't appear for a long time after a person is infected, the bulk of CD4 T cell loss happens during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body. 95 The reason for the preferential loss of mucosal CD4 T cells is that the majority of mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to gain 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 illness and seeks out. 98 A vigorous immune response eventually controls the disease and starts the clinically latent period. CD4 T cells in mucosal tissues stay particularly affected. 98 Continuous 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 action of several HIV gene products and also the immune response to continuing HIV replication. Additionally it is 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

Culloden, 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 advocated by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Additionally, testing is recommended 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 only discover when AIDS or acute immunodeficiency has become clear, they're infected at an advanced period of the disorder. Std Test near me Culloden, GA. 27

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Antibody evaluations in children younger than 18months are usually incorrect due to the ongoing presence of maternal antibodies 102 Thus 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 dependable PCR testing and several areas simply wait until either symptoms grow 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 inhabitants were aware of their HIV status. Culloden Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations 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-associated disorder for surveillance goals: 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 frequently adopted in developed nations. Since the WHO 's staging system doesn't require laboratory tests, it's suited to the resource-restricted states seen in developing countries, where it can 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 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's some evidence to imply that female condoms may provide an equivalent level of protection. Std test near me Culloden. 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 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female to male HIV transmission in regions with a high rates of HIV in 2007. 112 Nevertheless, whether it shields against male to female transmission is disputed, 113 114 and whether it is of benefit 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 option and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, thus negating its preventive effects. 119

Plans encouraging sexual abstinence do not appear to change subsequent HIV danger. 120 Evidence of any advantage from peer instruction is equally inferior. 121 Complete sexual education provided at school may decrease high risk behaviour. 122 A sizeable minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std test closest to GA United States. 123 Voluntary counselling and testing individuals for HIV does not change risky behavior in those who test negative but does increase condom use in those 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 an extremely productive method to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Culloden Georgia, 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 medications 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 youthful heterosexuals in Africa. 109 It may also be effective in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are combinations (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially therapy is usually a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog 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 aforementioned regimen loses effectiveness. 144

The World Health Organization and United States urges 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's recommended that it's continued without breaks or "holidays". 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 determine if treatment is powerful are initially urged 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 standards treatment is successful in more than 95% of individuals during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS as well as a reduced risk of death. Std test closest to Culloden Georgia. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added benefits include a decreased danger of transmission of the disease to sexual partners as well as a drop in mom-to-child transmission. The effectiveness of treatment depends to a big 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 issue with some medicines, 152 47% of people who desired them were taking them in the rate of adherence and also low and middle income nations as of 2010 143 is comparable in low income and high income countries. 153

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