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The first symptoms are followed by a stage called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second period of the natural history of HIV disease can continue from around 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 the stage a lot of people experience fever, weight loss, gastrointestinal difficulties 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 nearby Belle Rive Illinois. Belle Rive IL 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 tiny proportion (about 5%) keep elevated rates 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 "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 contaminated individuals. Belle Rive, Illinois 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 diseases in association with an HIV disease. Std test nearby Belle Rive Illinois 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 alarm 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

Individuals with AIDS have a higher 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 cause of death of nearly 16% of people with AIDS and is the first indication of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 and the white portion 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 individual. 11 The majority of all transmissions globally 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 America occurred among men who had sex with guys, with this population accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of homosexual and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std test closest to Belle Rive.

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 states. 51 In low-income countries, 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 countries are 0.04% per action for female-to-male transmission, and 0.08% per action for male-to-female transmission. 51 The risk of transmission from anal intercourse is especially high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it's still present. 53 The risk from getting oral sex has been described as "virtually nil"; 54 however, a couple cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 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 2nd most frequent way of HIV transmission is via blood and blood products. 11 Blood-borne transmission can be through needle-sharing needle stick injury, during intravenous drug use, transfusion of contaminated blood or blood product, or medical injections 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 IL 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 action and the danger following mucous membrane exposure to contaminated 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 places 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 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's estimated that up to 15% of HIV infections in these areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std test nearby IL, United States. 11 68 Although rare due to screening, it is likely to acquire 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 causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals 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 administering antiretroviral drugs to the newborn, averting breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those who do breastfeed. 76 Many of these measures are yet not accessible the developing world. 75 If blood contaminates food during pre- it might pose 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 characteristics. 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 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 resultant viral DNA is then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus may become latent, allowing its own host cell and the virus to avoid detection by the immune system. 83 Instead, the virus may be transcribed, creating new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that begin the replication cycle over. 84

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HIV is now known to distribute 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 can also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test near Belle Rive, Illinois. 86 87 The hybrid spreading mechanics of HIV lead to the continuing replication of the virus against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood after 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 noticeable 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 subsequently with antibody production, or seroconversion The CD8 T cell reaction is believed to be important in controlling virus amounts, 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 eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are essential to the immune response and without them, the body cannot fight diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 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 decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for decades after a person is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, particularly during the very first weeks of infection. 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 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. The infection is eventually controlled by 98 A vigorous immune response and initiates the latent stage. CD4 T cells in mucosal tissues stay especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation lasting throughout the long-term phase. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to HIV replication that is ongoing. It's also linked to the dysfunction 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

Belle Rive, IL 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 advised 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. 27 In many areas of the planet, a third of HIV carriers just find they're infected at an advanced phase of the disease when severe immunodeficiency or AIDS is now clear. Std Test nearby Belle Rive IL. 27

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Antibody evaluations in kids younger than 18months are typically inaccurate due to the continued 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 dependable PCR testing and a lot of areas just wait until either symptoms grow or the kid is old enough for precise antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Belle Rive Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which represented a considerable increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: the WHO disease staging system for HIV infection and disease , 24 and also 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 lab evaluations, it is suited to the resource-controlled conditions seen in developing countries, where it may 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 danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used 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 suggest that female condoms may offer an equivalent degree of protection. Std test in Belle Rive. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission due to its propensity 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female-to-male HIV transmission in places with a high rates of HIV in 2007. 112 However, whether it shields against male-to-female transmission is challenged, 113 114 and whether it is of advantage 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 understanding of exposure among circumcised men may cause more sexual risk-taking behavior, thereby negating its preventative effects. 119

Plans supporting sexual abstinence do not appear to impact subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally poor. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A substantial minority of young people continues to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std test in IL United States. 123 Voluntary counselling and testing individuals for HIV does not influence hazardous behavior in individuals who test negative but does raise condom use in those who test positive. 124 It isn't known 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 a very effective method to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test near me Belle Rive Illinois United States. 125 TASP is associated with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications 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 young heterosexuals in Africa. 109 It may also be successful in intravenous drug users using a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is commonly 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 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in individuals of all ages including pregnant women as soon as the diagnosis 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 people are diagnosed just after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is powerful are initially recommended after four weeks and once amounts fall below 50copies/mL checks every three to six months are usually sufficient. 27 Insufficient 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

Advantages of treatment include a decreased danger of death as well as a decreased risk of progression to AIDS. Std test in Belle Rive Illinois. 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 Additional advantages include a reduced risk of transmission to sexual partners of the illness as well as a decrease 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 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 medicines, 152 47% of people who wanted they were being taken by them in the rate of adherence and middle and low income nations as of 2010 143 is similar in low-income and high income countries. 153

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