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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or persistent HIV. 1 Without treatment, this second phase 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 at first, near the end of this phase a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months. Std test closest to Onarga, Illinois. Onarga, 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 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 individuals 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 individuals that are infected. Onarga, 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 Onarga Illinois United States. 26 In the absence of special 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 kind of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

People with AIDS have an increased 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 individuals with HIV. 35 The second most common cancer is lymphoma, which is the first hint of AIDS in 3 to 4% and is the cause of death of almost 16% of people with AIDS. 35 Both these cancers are related to 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 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 bulk of all transmissions worldwide 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 men, with this specific population accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive 49 About 15% of bisexual and homosexual men have HIV. 49 50 Std test nearby Onarga.

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 threat 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 action 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 homosexual contacts. 51 52 While the danger of transmission from oral sex is relatively low, it's still present. 53 The risk from receiving oral sex was described as "virtually nil"; 54 nonetheless, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings involving prostitution in low income countries, risk of female to male transmission has been estimated as 2.4% per action and male to female transmission as 0.05% per act. 51

The second 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 injections with unsterilized equipment. The threat from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test nearby IL United States. 63 The risk 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 hazard 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 some regions 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 nations the danger of getting 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 united kingdom the hazard 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 places come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test near me IL United States. 11 68 Although rare due to screening, it will be 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 leading to infection in the baby. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in people who also 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 could be reduced to about 1%. 73 Preventative treatment involves the mom preventing breastfeeding, taking antiretrovirals during pregnancy and delivery, an elective caesarean section, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the baby decrease the risk of transmission in those 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 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 responsible for long-duration sicknesses with a lengthy 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 resultant viral DNA is then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once integrated, the virus may become latent, allowing its own host cell and the virus to prevent detection by the immune system. 83 Instead, the virus might be transcribed, producing new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle afresh. 84

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HIV is now understood to distribute between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it uses hybrid spreading 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 can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std test near Onarga Illinois. 86 87 The hybrid spreading mechanics of HIV contribute to the virus's continuing replication against antiretroviral therapies. 85 88

Following the virus enters the body there is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked fall in the amount of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell response is regarded as significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it does not get rid of the virus a great CD8 T cell response has been associated with slower disease progression and a better prognosis. 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 infections or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 variable. During the chronic phase, the consequences 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 decrease in CD4 T cell numbers. 94

While 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 during the very first weeks of illness, particularly in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body. 95 The reason for 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 access 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 destroys CCR5 expressing CD4 T cells during acute disease and seeks out. The disease is eventually controlled by 98 A vigorous immune response and initiates the clinically latent stage. CD4 T cells in mucosal tissues remain especially changed. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the chronic period. 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 HIV replication that is ongoing. It's also linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Onarga, IL std test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers simply find they are infected at an advanced stage of the disease when acute immunodeficiency or AIDS has become apparent. Std test in Onarga IL. 27

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Antibody tests in children younger than 18months are usually erroneous due to the continuing 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 many areas just wait until either symptoms grow or the kid is old enough for accurate antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Onarga std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were analyzed 103 which signified a significant increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disorder for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 and the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently adopted in developed countries. Since the WHO 's staging system does not require lab evaluations, it's satisfied to the resource-controlled conditions encountered in developing countries, where it can be used to help direct clinical management. Despite their differences, the two systems enable comparison for statistical functions. 2 24 104

Consistent condom use reduces the risk 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 rate of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may provide an equal degree of protection. Std test in Onarga. 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 raise the risk of transmission because of 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, both UNAIDS and the World Health Organization advocated male circumcision as a way 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 contested, 113 114 and whether it's of advantage in developed countries 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 recommend 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 behaviour, hence negating its prophylactic effects. 119

Plans encouraging sexual abstinence don't seem to influence subsequent HIV danger. 120 Evidence of any advantage from peer instruction is equally inferior. 121 Comprehensive sexual education provided at school may decrease high risk behaviour. 122 A significant minority of young people proceeds to engage in high risk practices despite knowing about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std test near IL United States. 123 Voluntary counselling and testing people for HIV will not affect high-risk behavior in individuals who test negative but does raise condom use in individuals who test positive. 124 It is not understood 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 productive way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std Test nearest Onarga Illinois, United States. 125 TASP is related to a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (homework) 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 youthful heterosexuals in Africa. 109 It can also be effective in intravenous drug users with a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three medications belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially therapy is usually 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 Mixtures of agents which include protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it is recommended that it is continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is successful are initially urged after four weeks and once amounts fall below 50copies/mL checks every three to six months are generally adequate. 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 first year. 27

Benefits of treatment contain a decreased danger of departure as well as a decreased risk of progression to AIDS. Std Test near Onarga Illinois. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced danger of transmission to sexual partners of the disease and a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a large 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 though price is an important problem with some medications, 152 47% of people who desired them were taking them in low and middle income nations as of 2010 143 and also the speed of adherence is similar in low income and high-income nations. 153

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