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The initial symptoms are followed by a period called asymptomatic HIV clinical latency, or long-term HIV. 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 commonly there are few or no symptoms initially, close to the end of the phase 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 , defined 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 nearest Taylorville Illinois. Taylorville IL Std Test. 2

Although most HIV-1 infected people have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a tiny proportion (about 5%) keep high 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 those who keep a low or undetectable viral load without anti-retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent about 1 in 300 individuals that are contaminated. Taylorville 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 diseases in association with an HIV infection. Std test nearest Taylorville 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 common first conditions that alert 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

Individuals 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 individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people with AIDS and is the first 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 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 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 yet, the routine of transmission varies significantly among states. As of 2014, most HIV transmission in the USA 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 gay and bisexual guys have HIV. 49 50 Std Test closest to Taylorville.

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 countries. 51 In low-income nations, the danger 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 action 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 action in both heterosexual and homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The risk from getting oral sex was described as "almost nil"; 54 however, 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 action. 51

The 2nd most frequent way 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 contaminated 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 in IL, United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected person 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 action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in certain places more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the risk of acquiring 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 instance, in the UK the risk 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 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 because of screening, it will be 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 infant. 73 74 This is the third most common manner 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 those who also 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 Preventive treatment involves the mom avoiding 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 decline the risk of transmission in people who do breastfeed. Many of these measures are however not obtainable in the developing world. 75 If food is contaminated by blood during pre- it might present a risk 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 in charge of long-duration sicknesses using 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 resulting 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, enabling the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus might be transcribed, creating viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it uses crossed spreading mechanisms. 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 procedure of cell-to-cell spread. Std Test nearest Taylorville, Illinois. 86 87 The hybrid distributing mechanics of HIV lead to the virus's ongoing replication against antiretroviral treatments. 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 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 nearly invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell reaction is believed to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to slower disease progression as well as a better prognosis, though it doesn't remove the virus. 92

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Ultimately, 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 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 may also be a factor. 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 seem to account for the slow decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for years after a person is infected, the bulk of CD4 T cell loss happens during the very first weeks of illness, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body. 95 The reason for 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 obtain access to the cells, whereas merely a little 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 illness. 98 A vigorous immune response initiates the latent phase and controls the disease. CD4 T cells in mucosal tissues remain particularly affected. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of several HIV gene products and also 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

Taylorville, 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 recommended by the United States Preventive Services Task Force for all folks 15years to 65years of age 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 world, a third of HIV carriers only discover when AIDS or severe immunodeficiency has become evident they are infected at an advanced period of the disease. Std Test near me Taylorville, IL. 27

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Antibody evaluations in children younger than 18months are commonly incorrect due to the ongoing presence of maternal antibodies 102 Thus 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 a lot of places just wait until either symptoms grow or the child is old enough for accurate antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. Taylorville 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-related disease 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 often adopted in developed nations. Since the WHO 's staging system does not require laboratory tests, it is satisfied to the resource-restricted states encountered in developing countries, where it can be used to help guide 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 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 nearby Taylorville. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission due to its propensity to cause rectal and vaginal 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 2007 in areas using a high rates of HIV. 112 Nonetheless, whether it shields against male to female transmission is challenged, 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, however, does recommend 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 understanding of vulnerability among circumcised men may cause more sexual risk taking behaviour, hence negating its preventative effects. 119

Programs supporting sexual abstinence do not seem to impact subsequent HIV risk. 120 Signs of any gain from peer instruction is equally inferior. 121 Complete sexual education provided at school may decrease high risk behaviour. 122 A substantial minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std test nearest IL, United States. 123 Voluntary counseling and testing individuals for HIV will not influence risky behavior in those 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 effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is a very productive method to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std test near me Taylorville Illinois United States. 125 TASP is related to a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications 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 youthful heterosexuals in Africa. 109 It can also be effective in intravenous drug users with a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially treatment is commonly 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 Combinations 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 folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it's advised that it is continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is successful are initially recommended after four weeks and once levels fall below 50copies/mL tests every three to six months are typically sufficient. 27 Insufficient 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 very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS as well as a decreased risk of death. Std test nearest Taylorville 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 Added benefits include a reduced risk of transmission to sexual partners of the illness and a reduction in mom-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Rationales for non-adherence include poor access to medical care, 149 insufficient 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 cost is an important problem with some medications, 152 47% of those who desired them were taking them in middle and low income countries as of 2010 143 and the speed of adherence is similar in low income and high-income countries. 153

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