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The first symptoms are followed by a period called clinical latency, asymptomatic HIV, or persistent HIV. 1 Without treatment, this second stage 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 typically there are few or no symptoms in the beginning, near the end of this phase lots of people experience weight loss, fever, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also develop 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 closest to Sparta Georgia. Sparta 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 small percentage (about 5%) keep elevated amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These people are classified as HIV accountants or long-term nonprogressors (LTNP). 31 Another group consists of those who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent about 1 in 300 persons that are infected. Sparta 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 near Sparta 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 initial conditions that alert 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

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 typical cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people who have AIDS and is the initial hint of AIDS in 3 to 4%. 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 inner part of eyelids as well as 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 people 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 guys, with this particular public accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of gay and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test closest to Sparta.

With respect to unprotected heterosexual contacts, estimates 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 action, and of male-to-female transmission as 0.30% per act; the equivalent approximations for high income states are 0.04% per action 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 comparatively low, it is still present. 53 The risk from receiving oral sex was described as "virtually nil"; 54 however, a few 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 was estimated as 2.4% per act and male-to-female transmission as 0.05% per act. 51

The next 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 infected blood or blood product, or medical injections with unsterilized equipment. The threat from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std test near GA United States. 63 The risk 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 USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the danger of getting 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 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 appropriately 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 infections. Std Test near GA United States. 11 68 Although rare because of screening, it really is possible to get HIV from tissue and organ transplantation 69

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HIV could 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 lack of treatment, the risk of transmission before or during birth is around 20% and in those who additionally breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventative treatment includes the mom averting 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 infant decline the danger of transmission in people who do breastfeed. 76 Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it may introduce 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically accountable 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The consequent 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 integrated, the virus might become latent, allowing the virus and its own host cell to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, producing new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle over. 84

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HIV is now understood to disperse between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it uses 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 procedure for cell-to-cell spread. Std Test near me Sparta Georgia. 86 87 The hybrid dispersing mechanics of HIV lead to the virus's on-going replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood following the virus enters the body. During primary infection, the amount 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 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 believed to be significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been linked to slower disease progression along with a better prognosis, though it doesn't remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are essential to the immune response 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 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 may also be a factor. 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 appear to account for the slow decrease 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 happens during the first weeks of disease, especially in the intestinal mucosa, which harbors nearly all 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 only a small fraction of CD4 T cells in the bloodstream do thus. 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 illness. 98 A vigorous immune response controls the infection and begins the clinically latent phase. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation continuing 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 the immune response and also several HIV gene products to continuing HIV replication. Additionally it is linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier resulting from the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Sparta, GA Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone. 27 In many areas of the world, a third of HIV carriers only find when AIDS or acute immunodeficiency is now evident, they're infected at an advanced stage of the disease. Std Test nearby Sparta, GA. 27

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Antibody evaluations in children younger than 18months are commonly inaccurate due to the continued existence of maternal antibodies 102 Thus 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 reliable PCR testing and lots of places simply wait the child is old enough for exact antibody testing or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Sparta Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which represented a substantial increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance purposes: the WHO disorder staging system for HIV infection and disease , 24 and 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 need laboratory tests, it is satisfied to the resource-restricted conditions seen in developing countries, where it can also be used to help direct clinical management. Despite their differences, the two systems permit comparison for statistical functions. 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 speed of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may provide an equivalent degree of protection. Std test nearest Sparta. 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 because of its propensity to cause vaginal and rectal 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, both the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female-to-male HIV transmission in areas with a high rates of HIV in 2007. 112 Yet, whether it protects against male-to-female transmission is contested, 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, however, does advocate 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 perception of vulnerability among circumcised men may cause more sexual risk-taking behavior, hence negating its prophylactic effects. 119

Plans encouraging sexual abstinence don't seem to change subsequent HIV danger. 120 Signs of any advantage from peer education is equally poor. 121 Complete sexual education provided at school may fall high risk behaviour. 122 A substantial minority of young people proceeds to participate in high risk practices despite knowing about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std Test near me GA, United States. 123 Voluntary counseling and testing individuals for HIV does not change high-risk 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 people with HIV whose CD4 count 550 cells/L is quite an effective method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test near me Sparta 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 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 can also be effective in intravenous drug users with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

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

The World Health Organization and United States advocates antiretrovirals in individuals of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 Once treatment is begun it's advised that it's continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired result of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is successful are initially recommended after four weeks and once degrees drop below 50copies/mL checks every three to six months are generally 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 folks during the very first year. 27

Advantages of treatment contain a decreased danger of death and also a reduced risk of progression to AIDS. Std Test nearest Sparta Georgia. Physical and mental health also enhances. 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 and also a drop in mom-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Motives 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 though price is an important problem with some medications, 152 47% of those who desired they were being taken by them in the rate of adherence and middle and low income nations as of 2010 143 is comparable in low-income and high income countries. 153

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