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The initial symptoms are followed by a stage called asymptomatic HIV clinical latency, or long-term HIV. 1 Without treatment, this second phase of the natural history of HIV infection can last from around three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms initially, near the end of the period many people experience fever, weight loss, gastrointestinal problems 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 near me Elizabethtown Illinois. Elizabethtown, 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 proportion (about 5%) keep elevated levels 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 keep a low or undetectable viral load without anti-retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent around 1 in 300 infected persons. Elizabethtown 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 disorders in association with an HIV disease. Std test nearby Elizabethtown Illinois United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alarm 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, that is the cause of death of nearly 16% of people with AIDS and is the first sign 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 because of 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 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 person. 11 The majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this particular population 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 gay and bisexual men have HIV. 49 50 Std Test in Elizabethtown.

With respect 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 risk of female to male transmission is estimated as 0.38% per action, and of male-to-female transmission as 0.30% per action; the equivalent approximations for high-income countries are 0.04% per act for female to male transmission, and 0.08% per act for male-to-female transmission. 51 The danger 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 danger of transmission from oral sex is relatively low, it is still present. 53 The risk from getting oral sex has been described as "virtually 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 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 needle stick injury, during intravenous drug use, transfusion of infected blood or blood product, or medical shots with unsterilized equipment. The threat from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test nearby IL United States. 63 The danger of acquiring 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 act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in certain regions more than 80% of people 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 acquiring 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 danger 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'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 nearest IL, United States. 11 68 Although rare due to screening, it is possible to get HIV from organ and tissue transplantation 69

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HIV can 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 manner in which HIV is transmitted worldwide. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in individuals who also breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the danger of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment includes the mother preventing 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 decrease the danger of transmission in people who do breastfeed. 76 Many of these measures are nevertheless not accessible the developing world. 75 If food is contaminated by blood during pre- it might present 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically in charge of long-duration illnesses with a 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's transported together with the viral genome in the virus particle. The resultant 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 may become latent, allowing the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, producing viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it applies hybrid 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 of cell-to-cell spread. Std Test closest to Elizabethtown, Illinois. 86 87 The hybrid dispersing mechanisms of HIV contribute to the virus's on-going replication against antiretroviral therapies. 85 88

After the virus enters the body there is a period of rapid viral replication, leading to plenty of virus in the peripheral blood. During primary infection, the amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a marked fall in the amount 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 response is regarded as significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been linked to a better prognosis along with slower disease progression, though it does not eliminate 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 diseases or kill cells that are cancerous. 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 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 seem to account for the slow decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for a long time after an individual is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body, especially during the first weeks of illness. 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 seeks out and destroys CCR5 expressing CD4 T cells during acute disease. 98 A vigorous immune response controls the disease and begins the latent phase. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the chronic period. 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 ongoing HIV replication. It's 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

Elizabethtown, IL 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 recommended by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Furthermore, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the planet, a third of HIV carriers only discover when acute immunodeficiency or AIDS is now evident they are infected at an advanced period of the disease. Std test nearest Elizabethtown IL. 27

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Antibody tests in kids younger than 18months are usually inaccurate because of the ongoing 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 reliable PCR testing and a lot of places just wait until either symptoms develop or the child is old enough for antibody testing that is precise. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were aware of their HIV status. Elizabethtown std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 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 goals: the WHO disorder 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 often adopted in developed countries. Since the WHO 's staging system doesn't require laboratory evaluations, it's satisfied to the resource-controlled conditions encountered in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems allow 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 offer an equivalent level of protection. Std Test near Elizabethtown. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission because of its tendency 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female-to-male HIV transmission in regions with a high rates of HIV in 2007. 112 Nonetheless, whether it protects against male-to-female transmission is contested, 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 as an alternative with men who have sex with men. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, thereby negating its preventive effects. 119

Plans encouraging sexual abstinence do not appear to affect subsequent HIV danger. 120 Evidence of any advantage from peer education is equally poor. 121 Complete sexual education provided at school may decrease high risk behaviour. 122 A significant minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std test nearest IL, United States. 123 Voluntary counselling and testing people for HIV will not influence hazardous behavior in individuals who test negative but does increase 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 an extremely effective method to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test near Elizabethtown Illinois, United States. 125 TASP is connected with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the drugs tenofovir , with or without emtricitabine , is effective 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 might also be effective in intravenous drug users with a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two kinds, 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 including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is started it's advised that it is continued without breaks or "vacations". 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 Degrees to find out if treatment is effective are initially advocated after four weeks and once levels drop 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 standards treatment is effective in more than 95% of individuals during the first year. 27

Benefits of treatment include a decreased risk of progression to AIDS and also a decreased risk of death. Std Test near Elizabethtown Illinois. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a decreased danger of transmission of the illness to sexual partners and a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on compliance. 27 Reasons 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 Even though price is an important issue with some medicines, 152 47% of those who needed they were being taken by them in the rate of adherence and also middle and low income nations as of 2010 143 is comparable in low income and high income states. 153

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