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The first symptoms are followed by a stage called clinical latency, asymptomatic HIV, or persistent HIV. 1 Without treatment, this second stage 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 generally there are few or no symptoms in the beginning, near the end of this stage lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the crotch) for over three to six months. Std test in Lookout Mountain Georgia. Lookout Mountain GA 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 high amounts 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 antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent about 1 in 300 individuals that are contaminated. Lookout Mountain, 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 occurrence of specific disorders in association with an HIV infection. Std Test near me Lookout Mountain Georgia United States. 26 In the absence 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 form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have an increased 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first hint of AIDS in 3 to 4% and is the cause of death of nearly 16% of people with AIDS. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often 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 and also the white part 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 majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among countries. 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 bisexual and gay guys have HIV. 49 50 Std test nearest Lookout Mountain.

With respect 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 countries. 51 In low income nations, the danger of female to male transmission is estimated as 0.38% per act, and of male to female transmission as 0.30% per action; the equivalent estimates for high-income countries are 0.04% per action for female-to-male transmission, and 0.08% per action 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 homosexual contacts. 51 52 While the risk of transmission from oral sex is relatively low, it's still present. 53 The danger from getting oral sex has been described as "virtually nil"; 54 yet, a few cases 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 was estimated as 2.4% per action and male to female transmission as 0.05% per action. 51

The 2nd most frequent mode 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 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 near GA, 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 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 some regions 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 countries the danger 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 instance, 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'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 near GA 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 can 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 manner in which HIV is transmitted globally. 11 In the absence of treatment, the danger 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 appropriate treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Prophylactic treatment includes the mom avoiding 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 risk of transmission in people who do breastfeed. Many of these measures are nevertheless not available in the developing world. 75 If blood contaminates food during pre- chewing it may present a risk 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 using a very 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 (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 resulting 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 own host cell and the virus to prevent detection by the immune system. 83 Instead, the virus might be transcribed, generating new RNA genomes and viral proteins that 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 employs hybrid spreading mechanisms. 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 can also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test in Lookout Mountain, Georgia. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's on-going replication against antiretroviral therapies. 85 88

Following the virus enters the body there's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood. 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 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 subsequently with antibody generation, or seroconversion The CD8 T cell reaction is considered to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't eliminate the virus a great CD8 T cell response has been linked to slower disease progression along with a better prognosis. 92

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Finally, 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 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 factor. During the chronic phase, 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

Even though the symptoms of immune deficiency feature of AIDS do not appear for a long time after an individual is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found in the body, particularly during the first weeks of infection. 95 The reason behind 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 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 seeks out and destroys CCR5 expressing CD4 T cells during acute disease. 98 A vigorous immune response initiates the latent period and controls the infection. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation lasting throughout the chronic stage. 99 Immune activation, which is represented 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 continuing. 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

Lookout Mountain, GA Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers just find when AIDS or acute immunodeficiency has become obvious they're infected at an advanced phase of the disease. Std test in Lookout Mountain, GA. 27

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Antibody tests in children younger than 18months are commonly erroneous due to the continued presence 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 dependable PCR testing and lots of areas simply 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 people were informed of their HIV status. Lookout Mountain std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were examined 103 which signified a significant increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disorder for surveillance goals: the WHO disorder 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 countries. Since the WHO 's staging system does not need laboratory evaluations, it's satisfied to the resource-restricted states seen in developing countries, where it can be utilized to help direct clinical management. Despite their differences, both 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 person is infected, the rate 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 in Lookout Mountain. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission due to its tendency to cause rectal and vaginal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual guys by between 38% and 66% over 24 months". 111 Due to these studies UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female-to-male HIV transmission in areas using a high rates of HIV in 2007. 112 Yet, whether it protects against male-to-female transmission is challenged, 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 alternative and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behavior, thereby negating its preventative effects. 119

Plans supporting sexual abstinence do not appear to change subsequent HIV danger. 120 Signs of any advantage from peer education is equally inferior. 121 Comprehensive sexual education provided at school may fall high risk behavior. 122 A significant minority of young people continues to engage in high risk practices despite knowing 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 doesn't change hazardous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It is not understood 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 way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test in Lookout Mountain 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 drugs tenofovir , with or without emtricitabine , is effective in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It may also be effective in intravenous drug users with a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes," 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 include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends 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 folks 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 advised that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desirable 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 degrees drop below 50copies/mL tests every three to six months are usually sufficient. 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 first year. 27

Benefits of treatment include a decreased risk of departure as well as a reduced risk of progression to AIDS. Std test nearest Lookout Mountain, Georgia. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a reduced risk of transmission of the disease to sexual partners and also 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 complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 Even though price is an important issue with some drugs, 152 47% of those who needed them were taking them in the rate of adherence as well as middle and low income nations as of 2010 143 is comparable in low-income and high income states. 153

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