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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or persistent HIV. 1 Without treatment, this second phase 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 usually there are few or no symptoms initially, near the end of this period lots of people experience weight loss, fever, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test closest to Seatonville Illinois. Seatonville, 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 little percentage (about 5%) retain 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 accountants 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 "top-notch suppressors". They represent approximately 1 in 300 contaminated individuals. Seatonville 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 closest to Seatonville Illinois United States. 26 In the absence of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alert to the presence 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 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 people with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of almost 16% of people with AIDS and is the initial indication of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids as well as the white portion 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 bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this people 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 gay guys have HIV. 49 50 Std test nearest Seatonville.

With regard 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 nations. 51 In low-income nations, 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 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 homosexual contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it's still present. 53 The risk from receiving oral sex has been described as "almost nil"; 54 however, 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 has been estimated as 2.4% per act and male to female transmission as 0.05% per action. 51

The next 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 shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test closest to IL, United States. 63 The risk of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per act and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some regions 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 countries the risk 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 instance, in the UK 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 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 near IL, United States. 11 68 Although rare due to screening, it will be possible to get 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 those 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 risk of mother-to-child infection could be reduced to about 1%. 73 Preventive 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 either the mother or the infant decline the risk of transmission in those who do breastfeed. 76 Many of these measures are nevertheless not available in the developing world. 75 If blood contaminates food during pre- it might pose 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 illnesses with an extended 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 together with the viral genome in the virus particle. The resulting 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 might become latent, enabling its host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, creating new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that begin the replication cycle afresh. 84

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HIV is now understood to spread between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it employs 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 nearest Seatonville, Illinois. 86 87 The hybrid spreading mechanisms of HIV lead to the ongoing replication of the virus against antiretroviral therapies. 85 88

There's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood after the virus enters the body. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a marked drop in the amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is thought to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it will not eliminate the virus a great CD8 T cell response was linked to slower disease progression along with a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens 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 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 phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells seem to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS do not appear for decades after someone is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, particularly during the very first weeks of disease. 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 access the cells, whereas only 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 illness. 98 A vigorous immune response controls the disease and starts the clinically latent phase. CD4 T cells in mucosal tissues remain particularly changed. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the chronic stage. 99 Immune activation, which is represented 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. Additionally it is linked to the breakdown 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

Seatonville IL Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the presence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many sections of the planet, a third of HIV carriers simply find they are infected at an advanced phase of the disease when AIDS or severe immunodeficiency is now evident. Std Test nearest Seatonville IL. 27

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Antibody evaluations in kids younger than 18months are normally incorrect because of the continued presence of maternal antibodies 102 Consequently 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 dependable PCR testing and a lot of places simply 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 public were aware of their HIV status. Seatonville Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were examined 103 which signified a substantial increase compared to previous years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related ailment for surveillance purposes: the WHO disorder 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 frequently adopted in developed countries. Since the WHO 's staging system doesn't require lab 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 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 person is infected, the speed 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 nearest Seatonville. 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 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 the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female to male HIV transmission in areas using a high rates of HIV in 2007. 112 However, whether it shields against male-to-female transmission is contested, 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, nevertheless, does that it be discussed as an option with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts fear that a lower understanding of exposure among circumcised men may cause more sexual risk taking behavior, thus negating its prophylactic effects. 119

Programs supporting sexual abstinence don't seem to affect subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A significant minority of young people proceeds to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std Test nearby IL United States. 123 Voluntary counseling and testing people for HIV will not affect hazardous behaviour in individuals who test negative but does increase condom use in individuals who test positive. 124 It is not known 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 way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test near me Seatonville 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 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 might also be effective in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

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

United States and the World Health Organization urges antiretrovirals in individuals of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it's recommended that it is continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desirable results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is effective are initially urged after four weeks and once amounts fall below 50copies/mL tests 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 folks during the first year. 27

Advantages of treatment include a reduced risk of progression to AIDS as well as a decreased danger of death. Std test nearby Seatonville Illinois. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased danger of transmission of the disease to sexual partners as well as a reduction in mother-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Reasons 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 problem with some medications, 152 47% of those who wanted they were being taken by them in low and middle income nations as of 2010 143 and the rate of adherence is comparable in low income and high-income nations. 153

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