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The first symptoms are followed by a stage called persistent HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second stage of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms initially, close to the end of this phase many people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , characterized 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 in Winder, Georgia. Winder, 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 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 accountants 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 persons that are contaminated. Winder 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 Winder Georgia United States. 26 In the absence of particular treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common first conditions that alert to the existence 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 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 people with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people with 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 due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner 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 person. 11 The bulk 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 specific population 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 nearby Winder.

With regard to unprotected heterosexual contacts, estimates of the risk 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 nations, the danger 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 estimates for high income nations 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 is still present. 53 The risk from receiving oral sex has been described as "virtually nil"; 54 nonetheless, a few cases have been 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 act and male-to-female transmission as 0.05% per act. 51

The next 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 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 act, with an average of 0.8%. Std Test in GA, United States. 63 The danger 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 threat following mucous membrane exposure to infected 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 certain 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 nations the risk 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 instance, in the united kingdom 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 diseases. Std test closest to GA United States. 11 68 Although rare due to screening, it really is possible to get HIV from organ and tissue transplantation 69

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HIV could 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 way in which HIV is transmitted internationally. 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, 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 involves the mother 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 risk of transmission in those who do breastfeed. 76 Many of these measures are nevertheless not obtainable in the developing world. 75 If food is contaminated by blood during pre- it might introduce a threat 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 sicknesses with an extended 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's transported together with the viral genome in the virus particle. The consequent viral DNA is then 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 host cell and the virus to prevent detection by the immune system. 83 Instead, the virus may be transcribed, creating new RNA genomes and viral proteins which 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 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 near me Winder, Georgia. 86 87 The hybrid spreading mechanisms of HIV lead to the ongoing replication of the virus against antiretroviral treatments. 85 88

Following the virus enters the body there's a period of rapid viral replication, resulting in plenty of virus in the peripheral blood. 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 number of circulating CD4 T cells. The acute viremia is almost always related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell reaction is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was associated with slower disease progression as well as a better prognosis, though it doesn't get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are crucial to the immune response and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the long-term and acute phases. 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 appear to account for the slow decrease in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency feature of AIDS do not appear for years after someone is infected, the majority of CD4 T cell loss happens during the first weeks of infection, especially in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body. 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 gain access to the cells, whereas merely 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 destroys CCR5 expressing CD4 T cells during acute illness and seeks out. The disease is eventually controlled by 98 A vigorous immune response and begins the latent stage. CD4 T cells in mucosal tissues remain particularly affected. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the long-term phase. 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 HIV replication that is continuing. 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

Winder, GA std test. HIV/AIDS is diagnosed via lab testing and then staged based on the presence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Moreover, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many regions of the planet, a third of HIV carriers simply discover when severe immunodeficiency or AIDS is now apparent, they are infected at an advanced phase of the disease. Std Test closest to Winder GA. 27

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Antibody evaluations in kids younger than 18months are generally wrong due to the ongoing existence 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 lots of areas simply wait until either symptoms grow or the kid is old enough for antibody testing that is accurate. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Winder std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were tested 103 which represented a significant increase compared to preceding years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disease for surveillance purposes: 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 nations. Since the WHO 's staging system doesn't require lab tests, it is suited to the resource-controlled conditions encountered in developing countries, where it may also be used to help guide 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 individual is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to suggest that female condoms may provide an equal degree of protection. Std test nearest Winder. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission because of its propensity 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 advocated male circumcision as a way of preventing female to male HIV transmission in places using a high rates of HIV in 2007. 112 Nevertheless, whether it protects 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 recommend for all sexually active heterosexual males and that it be discussed with men who have sex with men as an alternative. 118 Some experts fear that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behavior, thereby negating its preventive effects. 119

Plans encouraging sexual abstinence don't seem to change subsequent HIV risk. 120 Signs of any benefit from peer instruction is equally poor. 121 Comprehensive sexual education provided at school may fall high risk behaviour. 122 A considerable 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 GA, United States. 123 Voluntary counseling and testing individuals for HIV doesn't change high-risk behaviour in those 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 individuals with HIV whose CD4 count 550 cells/L is a very effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test near Winder 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 might also be successful in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART options are blends (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," 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 contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Mixtures 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 folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it is recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desired outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is effective are initially advocated after four weeks and once levels fall below 50copies/mL checks every three to six months are usually adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of folks during the first year. 27

Benefits of treatment contain a reduced risk of progression to AIDS and also a decreased risk of death. Std Test nearest Winder, Georgia. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased risk of transmission of the disease to sexual partners as well as a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 27 Rationales for non-adherence include poor access to medical care, 149 inadequate 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 price is an important problem with some drugs, 152 47% of those who desired they were being taken by them in low and middle income nations as of 2010 143 as well as the speed of adherence is similar in low income and high-income countries. 153

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