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The initial symptoms are followed by a period called asymptomatic HIV clinical latency, or continual HIV. 1 Without treatment, this second stage of the natural history of HIV disease can last from around three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms at first, close to the end of this phase lots of people experience gastrointestinal problems, weight loss, fever 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 groin) for over three to six months. Std Test nearest Crest Hill, Illinois. Crest Hill, 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 small percentage (about 5%) keep high 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 those who maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 individuals that are infected. Crest Hill 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 occurrence of specific disorders in association with an HIV disease. Std test in Crest Hill Illinois, United States. 26 In the lack 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 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

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 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 indication of AIDS in 3 to 4%. 35 Both these cancers are related to 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 and 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 individual. 11 The majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, 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 people accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of homosexual and bisexual guys have HIV. 49 50 Std Test near Crest Hill.

With regard to unprotected heterosexual contacts, approximations 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 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 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 gay 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 "nearly nil"; 54 nonetheless, a few instances are 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 has been estimated as 2.4% per act and male-to-female transmission as 0.05% per act. 51

The 2nd most common way 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 shots with unsterilized equipment. The danger from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test nearest IL United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in certain 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 extremely low (less than one in half a million) where improved donor selection and HIV screening is performed; 11 for example, in the UK 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 suitably 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 nearby IL, United States. 11 68 Although rare due to screening, it's possible to get HIV from tissue and organ transplantation 69

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HIV can 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 way 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, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection may be reduced to about 1%. 73 Prophylactic treatment includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the danger of transmission in those who do breastfeed. Many of these measures are nevertheless not accessible the developing world. 75 If food is contaminated by blood during pre- it might introduce a threat of transmission. 71

HIV is a part 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 accountable for long-duration sicknesses with a lengthy 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 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 cofactors. 82 Once incorporated, the virus may become latent, enabling its host cell and the virus to avoid detection by the immune system. 83 Instead, the virus could be transcribed, generating 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 spread between CD4 T cells by two parallel routes: 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 then 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 closest to Crest Hill Illinois. 86 87 The hybrid dispersing mechanics of HIV contribute to the continuing replication of the virus against antiretroviral therapies. 85 88

There is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood, after 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 number of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently 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 as well as a better prognosis, though it does not get rid of 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 infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 period, the results of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for decades after a person is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found within the body, particularly during the very first weeks of infection. 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 just a tiny 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 infection. The infection is eventually controlled by 98 A vigorous immune response and starts the latent stage. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products as well as the immune response to HIV replication that is continuing. It is also linked to the dysfunction 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

Crest Hill 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 Also, testing is suggested for those at high risk, which includes anyone. 27 In many regions of the planet, a third of HIV carriers just discover when acute immunodeficiency or AIDS has become evident they are infected at an advanced phase of the disease. Std Test nearest Crest Hill, IL. 27

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Antibody evaluations in children younger than 18months are usually wrong because of the continuing presence 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 trusted PCR testing and many areas just wait the kid is old enough for antibody testing that is accurate or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were aware of their HIV status. Crest Hill std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were tested 103 which signified a considerable increase compared to preceding years. 103

Two primary 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 embraced in developed nations. Since the WHO 's staging system does not need lab evaluations, it is suited to the resource-restricted conditions encountered 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 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 offer an equivalent level of protection. Std Test near Crest Hill. 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 raise 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 men by between 38% and 66% over 24 months". 111 Due to these studies UNAIDS and the World Health Organization advocated 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 shields against male to female transmission is questioned, 113 114 and whether it is of advantage in developed countries 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 with men who have sex with men as an alternative. 118 Some experts worry that a lower perception of exposure among circumcised men may cause more sexual risk-taking behaviour, hence negating its preventive effects. 119

Programs supporting sexual abstinence don't appear to change subsequent HIV danger. 120 Signs of any gain from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A sizeable minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test near IL, United States. 123 Voluntary counseling and testing people for HIV does not influence risky behaviour in those who test negative but does increase condom use in individuals who test positive. 124 It is not understood 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 method to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test near Crest Hill Illinois 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 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 can also be effective in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are mixtures (or "cocktails") consisting of at least three medications belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is generally 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 Combinations of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it is advised that it's continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is powerful are initially advocated after four weeks and once degrees drop below 50copies/mL checks every three to six months are generally adequate. 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 first year. 27

Advantages of treatment include a reduced risk of progression to AIDS as well as a reduced danger of departure. Std Test near Crest Hill, Illinois. 147 In the developing world treatment also enhances physical and mental health. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a decreased risk of transmission of the illness to sexual partners and also a reduction in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable 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 complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 though cost is an important problem with some medicines, 152 47% of those who desired they were being taken by them in middle and low income nations as of 2010 143 and the speed of adherence is comparable in low income and high-income countries. 153

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