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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. 1 Without treatment, this second phase 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 generally there are few or no symptoms at first, near the end of the phase a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , characterized 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 near me Pavo, Georgia. Pavo, 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 elevated 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 people who keep a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 infected individuals. Pavo 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 disease. Std test nearby Pavo 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 often occurring first conditions that alert 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

People 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 common cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the initial sign of AIDS in 3 to 4% and is the cause of death of almost 16% of individuals with AIDS. 35 Both these cancers are related to 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 also the white part of the eye) is also more prevalent 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 yet, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this particular people accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of homosexual and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std Test nearby Pavo.

With respect to unprotected heterosexual contacts, estimates 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 countries. 51 In low income countries, the risk 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 nations 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 homosexual contacts. 51 52 While the risk of transmission from oral sex is relatively low, it is still present. 53 The risk from getting oral sex has been described as "virtually nil"; 54 nevertheless, a few 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 act and male to female transmission as 0.05% per action. 51

The second most common 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 infected blood or blood product, or medical injections with unsterilized equipment. The threat from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test closest to 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 act and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few 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 countries 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 instance, in the united kingdom the threat 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 infections. Std Test near GA United States. 11 68 Although rare because of screening, it will be likely to acquire HIV from organ and tissue transplantation 69

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HIV can 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 globally. 11 In the absence of treatment, the risk of transmission before or during birth is around 20% and in those who also 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 Preventive 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 decrease the danger of transmission in those who do breastfeed. Many of these measures are nevertheless not available in the developing world. 75 If blood contaminates food during pre- chewing it might present a risk 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 illnesses 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 (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 consequent 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 incorporated, the virus may become latent, allowing the virus and its particular host cell to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, producing new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle anew. 84

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HIV is now understood to distribute between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it employs crossed spreading 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 can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test in Pavo, Georgia. 86 87 The hybrid distributing mechanisms of HIV lead to the virus's ongoing replication against antiretroviral therapies. 85 88

There is 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 noticeable fall in the amount of circulating CD4 T cells. The acute viremia is almost invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell response is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good has been associated with slower disease progression and a better prognosis, though it does not eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are critical to the immune response and without them, the body cannot fight infections or kill cancerous cells. 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 variable. During the chronic phase, the results of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells seem to account for the slow decline in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for years after an individual is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body, particularly during the very first weeks of disease. 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 only 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 initiates the clinically latent stage and eventually controls the infection. CD4 T cells in mucosal tissues remain particularly changed. 98 Continuous HIV replication causes a state of generalized immune activation lasting throughout the chronic stage. 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 and also the immune response to continuing HIV replication. 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

Pavo, 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 of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many sections of the planet, a third of HIV carriers simply discover when AIDS or acute immunodeficiency has become apparent they're infected at an advanced stage of the disease. Std test closest to Pavo GA. 27

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Antibody evaluations in children younger than 18months are normally erroneous because of 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 trusted PCR testing and several places just wait until either symptoms grow or the kid is old enough for antibody testing that is exact. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Pavo Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were examined 103 which signified a significant increase compared to preceding years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance purposes: 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 frequently embraced in developed countries. Since the WHO 's staging system doesn't require laboratory evaluations, it's suited to the resource-restricted states seen in developing countries, where it may 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 risk 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 rate of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may provide an equal degree of protection. Std test near Pavo. 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 tendency 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 UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female to male HIV transmission in 2007 in regions with a high rates of HIV. 112 However, whether it protects against male to female transmission is disputed, 113 114 and whether it's of advantage in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, nevertheless, does recommend for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behaviour, hence negating its prophylactic effects. 119

Programs supporting sexual abstinence don't seem to impact subsequent HIV danger. 120 Signs of any gain from peer education is equally inferior. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people proceeds to engage in high risk practices despite understanding about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std test nearest GA United States. 123 Voluntary counselling and testing people for HIV doesn't influence hazardous behavior in those who test negative but does increase 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 individuals with HIV whose CD4 count 550 cells/L is a very productive method to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std Test nearby Pavo Georgia, United States. 125 TASP is related to 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 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 successful in intravenous drug users using a study finding a reduction in risk 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 treatment is usually 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 mentioned regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's advised that it's continued without breaks or "vacations". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desired outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is successful are initially urged after four weeks and once amounts drop 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 standards treatment is effective in more than 95% of people during the very first year. 27

Advantages of treatment include a reduced risk of progression to AIDS and a reduced risk of death. Std Test near me Pavo Georgia. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced danger of transmission to sexual partners of the disease and a drop in mother-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Reasons 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 cost is an important issue with some medicines, 152 47% of those who wanted they were being taken by them in low and middle income countries as of 2010 143 and the speed of adherence is similar in low-income and high-income nations. 153

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