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The initial symptoms are followed by a period called continual HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase 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 typically there are few or no symptoms initially, near the end of this period a lot of people experience gastrointestinal problems, weight loss, fever and muscle pains. 1 Between 50 and 70% of individuals also grow 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 in Germantown Illinois. Germantown 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 little percentage (about 5%) keep elevated levels 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 those who keep a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 individuals that are infected. Germantown 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 infection. Std Test near me Germantown Illinois United States. 26 In the lack of specific treatment, around half of people 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 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 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first sign of AIDS in 3 to 4% and is the cause of death of almost 16% of individuals with AIDS. 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 interior part of eyelids and also 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this specific public 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 men have HIV. 49 50 Std test near Germantown.

With respect to unprotected heterosexual contacts, approximations of the danger 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 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 act; the equivalent approximations for high income states are 0.04% per act 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 gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from getting oral sex has been described as "almost nil"; 54 nonetheless, a couple cases 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 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 during intravenous drug use, needle stick injury, transfusion of infected blood or blood product, or medical shots with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std test in IL, United States. 63 The risk of getting 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 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 those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the risk 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 appropriately screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these places come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test near IL United States. 11 68 Although rare because of screening, it's likely 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 resulting in infection in the infant. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the lack 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 proper treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Prophylactic treatment involves the mother administering antiretroviral drugs to the newborn, avoiding 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 people who do breastfeed. Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it may introduce a danger of transmission. 71

HIV is an associate 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 responsible for long-duration illnesses using a very 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 consequent viral DNA is subsequently imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once incorporated, the virus may become latent, allowing the virus and its own host cell to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, producing viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle over and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel routes: 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 and then infect another T cell following a chance encounter. 85 HIV can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test in Germantown, Illinois. 86 87 The hybrid distributing mechanics of HIV lead to the virus's ongoing replication against antiretroviral therapies. 85 88

Following the virus enters the body there is a period of rapid viral replication, resulting in 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 reaction 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 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 a better prognosis and slower disease progression, though it will not eliminate the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are essential to the immune response and weakens the immune system 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 variable. 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

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for many years after a person is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found in the body, especially during the very first weeks of infection. 95 The reason for the preferential loss of mucosal CD4 T cells is that nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas merely a little 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. 98 A vigorous immune response begins the clinically latent phase and controls the infection. CD4 T cells in mucosal tissues remain especially affected. 98 Continuous HIV replication causes a state of generalized immune activation lasting throughout the long-term period. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of the immune response and several HIV gene products 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

Germantown 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 recommended by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many sections of the planet, a third of HIV carriers only find when severe immunodeficiency or AIDS has become apparent, they're infected at an advanced period of the disorder. Std Test near me Germantown, IL. 27

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Antibody tests in kids younger than 18months are typically incorrect due to the ongoing existence of maternal antibodies 102 So 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 reliable PCR testing and several places just wait until either symptoms grow or the child is old enough for antibody testing that is exact. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Germantown 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 principal clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 as well as 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 does not require laboratory evaluations, it is suited to the resource-controlled states encountered in developing countries, where it can be used to help direct 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 about 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 is some evidence to suggest that female condoms may provide an equivalent level of protection. Std Test nearby Germantown. 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 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, both UNAIDS and the World Health Organization advocated male circumcision as a way of preventing female to male HIV transmission in areas with a high rates of HIV in 2007. 112 Yet, whether it shields against male-to-female transmission is challenged, 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 as an option with men who have sex with men. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behavior, thereby negating its preventive effects. 119

Programs encouraging sexual abstinence do not appear to impact subsequent HIV risk. 120 Signs of any gain from peer instruction is equally poor. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A considerable minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std Test near IL, United States. 123 Voluntary counselling and testing people for HIV will not influence high-risk behaviour in individuals who test negative but does increase condom use in those who test positive. 124 It is not known whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is quite an effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearest Germantown Illinois United States. 125 TASP is associated with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) 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 young heterosexuals in Africa. 109 It might also be effective in intravenous drug users using a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

Current 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 treatment 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 Blends of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is started it is advised that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only 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 determine if treatment is successful are initially urged after four weeks and once levels fall below 50copies/mL tests every three to six months are generally sufficient. 27 Inadequate 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 very first year. 27

Benefits of treatment include a reduced risk of progression to AIDS and also a reduced danger of death. Std test closest to Germantown, Illinois. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased risk of transmission to sexual partners of the disease as well as a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on compliance. 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 Even though cost is an important issue with some medications, 152 47% of people who needed they were being taken by them in the speed of adherence and also middle and low income nations as of 2010 143 is similar in low-income and high income nations. 153

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