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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 period of the natural history of HIV disease 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, close to the end of this period many 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 near Camp Point Illinois. Camp Point IL 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 percentage (about 5%) retain 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 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 "elite controllers" or "elite suppressors". They represent approximately 1 in 300 infected persons. Camp Point, 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 infection. Std test closest to Camp Point 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 initial 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

People 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 individuals with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of nearly 16% of people who have AIDS and is the first signal of AIDS in 3 to 4%. 35 Both these cancers are associated 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 and also the white part of the eye) is also more common 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 bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this specific 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 closest to Camp Point.

With regard to unprotected heterosexual contacts, estimates 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 nations. 51 In low income countries, 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 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 act 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 receiving oral sex has been described as "almost nil"; 54 nevertheless, a couple instances are 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 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 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 in IL, 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 act and the danger following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in certain areas 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 example, 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 regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std test near IL, United States. 11 68 Although rare because of screening, it's possible to acquire 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 infant. 73 74 This is the third most common manner in which HIV is transmitted worldwide. 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 includes the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, 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 accessible the developing world. 75 If food is contaminated by blood during pre- chewing it may present a danger 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 in charge of long-duration sicknesses with a 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 (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 then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus may become latent, enabling the virus and its host cell to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, creating new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle anew. 84

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HIV is now known to disperse between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it uses crossed propagating mechanisms. 85 In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid then infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test near me Camp Point, Illinois. 86 87 The hybrid spreading mechanics of HIV contribute to the ongoing replication of the virus against antiretroviral treatments. 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 amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable fall in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell reaction is thought to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it does not remove the virus a great CD8 T cell response has been associated with slower disease progression and also a better prognosis. 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 long-term 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 may also be a factor. During the chronic phase, the effects 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

While the symptoms of immune deficiency feature of AIDS do not appear for decades after a person is infected, the majority of CD4 T cell loss occurs 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 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 tiny 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 infection and seeks out. 98 A vigorous immune response controls the disease and begins the clinically latent stage. CD4 T cells in mucosal tissues stay particularly affected. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic phase. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the action of several HIV gene products and 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

Camp Point IL std test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence 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 diagnosed with a sexually transmitted illness. 27 In many areas of the planet, a third of HIV carriers simply find when AIDS or acute immunodeficiency is now evident, they are infected at an advanced period of the disorder. Std Test in Camp Point IL. 27

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Antibody tests in kids younger than 18months are generally inaccurate because of the ongoing existence of maternal antibodies 102 So HIV infection 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 areas 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. Camp Point Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 103 which represented a significant increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated disorder 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 frequently embraced in developed nations. Since the WHO 's staging system doesn't need laboratory evaluations, it's satisfied to the resource-controlled states seen in developing countries, where it can also be used to help guide 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 individual is infected, the speed 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 nearby Camp Point. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems 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 due to its inclination 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, both the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female to male HIV transmission in regions with a high rates of HIV in 2007. 112 Nevertheless, whether it protects against male-to-female transmission is questioned, 113 114 and whether it's of benefit in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, 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 perception of vulnerability among circumcised men may cause more sexual risk taking behavior, thus negating its preventative effects. 119

Plans supporting sexual abstinence do not seem to affect subsequent HIV danger. 120 Signs of any advantage from peer education is equally poor. 121 Comprehensive sexual education provided at school may fall high risk behaviour. 122 A significant minority of young people proceeds 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 counseling and testing individuals for HIV does not change high-risk behaviour in individuals who test negative but does increase condom use in individuals who test positive. 124 It isn't known 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 productive way to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std test near Camp Point Illinois, United States. 125 TASP is associated with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications tenofovir , with or without emtricitabine , is successful in several 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 using a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is generally a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's advised that it is continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially recommended after four weeks and once degrees fall below 50copies/mL tests every three to six months are typically sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of folks during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS as well as a decreased danger of departure. Std test near Camp Point, Illinois. Physical and mental health also improves. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Added advantages include a reduced danger of transmission of the disease to sexual partners as well as a decrease in mom-to-child transmission. The effectiveness of treatment depends to a big part on compliance. 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 cost is an important issue with some drugs, 152 47% of people who needed they were being taken by them in the rate of adherence as well as middle and low income countries as of 2010 143 is comparable in low income and high income countries. 153

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