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The first symptoms are followed by a stage called asymptomatic HIV clinical latency, or continual 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 usually there are no or few symptoms in the beginning, near the end of the stage many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also develop persistent generalized lymphadenopathy , defined 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 Waynesville, Illinois. Waynesville, 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 small proportion (about 5%) retain 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 individuals who maintain a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent around 1 in 300 contaminated individuals. Waynesville, 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 in Waynesville 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 often occurring 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

Individuals with AIDS have an increased 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 people with HIV. 35 The second most common cancer is lymphoma, that is the initial indication of AIDS in 3 to 4% and is the cause of death of almost 16% of people who have AIDS. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 as well as the white part of the eye) is also more prevalent in those with HIV. 36

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The most frequent mode of transmission of HIV is through sexual contact with an infected individual. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, 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 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 near Waynesville.

With respect to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act seem to be four to ten times higher in low-income countries than in high-income countries. 51 In low income nations, 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 estimates for high-income nations are 0.04% per action for female to male transmission, and 0.08% per act for male to female transmission. 51 The danger of transmission from anal intercourse is especially high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex was described as "almost nil"; 54 yet, 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 was estimated as 2.4% per act and male-to-female transmission as 0.05% per action. 51

The next 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 risk from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test near 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 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 64 2009 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 infected blood. 63 In developed nations the danger 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 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 infected blood and blood products, representing between 5% and 10% of global diseases. Std test nearby IL, United States. 11 68 Although rare because of screening, it's possible to acquire HIV from tissue and organ transplantation 69

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HIV can be transmitted from mother to child during pregnancy, during delivery, or through breast milk causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted globally. 11 In the absence 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 may be reduced to about 1%. 73 Prophylactic treatment involves the mom 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 infant decline the danger of transmission in people who do breastfeed. 76 Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it may pose a risk of transmission. 71

HIV is a member 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 accountable for long-duration illnesses using a lengthy 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 resulting viral DNA is subsequently imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus may become latent, allowing the virus and its own host cell to avoid detection by the immune system. 83 Instead, the virus might be transcribed, producing viral proteins which are packaged and discharged 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 disperse between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it uses hybrid propagating mechanics. 85 In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid after which 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 Waynesville, Illinois. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's continuing replication against antiretroviral therapies. 85 88

There is a period of rapid viral replication, resulting in plenty of virus in the peripheral blood following 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 noticeable fall in the amount of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, 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 CD8 T cell response that was great has been linked to slower disease progression and also a better prognosis, though it does not eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are critical 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 long-term and acute 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 period, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS don't appear for decades after an individual is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, especially during the first weeks of illness. 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 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 destroys CCR5 expressing CD4 T cells during acute infection and seeks out. 98 A vigorous immune response controls the disease and starts the latent phase. CD4 T cells in mucosal tissues stay particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the chronic period. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the action of the immune response and several HIV gene products to ongoing HIV replication. It is 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

Waynesville, IL Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone. 27 In many sections of the planet, a third of HIV carriers simply discover when AIDS or acute immunodeficiency is now apparent, they are infected at an advanced stage of the disease. Std Test closest to Waynesville, IL. 27

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Antibody evaluations in children younger than 18months are commonly incorrect due to 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 reliable PCR testing and a lot of places just wait the kid is old enough for antibody testing that is exact or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Waynesville Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were examined 103 which signified a significant increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related disorder for surveillance goals: the WHO disease 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 doesn't require laboratory evaluations, it's satisfied to the resource-controlled conditions seen in developing countries, where it may also be used to help guide clinical management. Despite their differences, the two systems allow comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger 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's some evidence to suggest that female condoms may offer an equal degree of protection. Std test in Waynesville. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise 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 the World Health Organization and UNAIDS advocated male circumcision as a way of preventing female-to-male HIV transmission in places using a high rates of HIV in 2007. 112 Yet, whether it shields against male to female transmission is challenged, 113 114 and whether it's of advantage 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 with men who have sex with men as an alternative and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, hence negating its prophylactic effects. 119

Programs encouraging sexual abstinence do not seem to change 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 large minority of young people continues to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std test near IL, United States. 123 Voluntary counseling and testing individuals for HIV doesn't change dangerous behaviour in those who test negative but does raise condom use in individuals who test positive. 124 It isn't 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 an extremely effective method to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test near me Waynesville Illinois United States. 125 TASP is associated with 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 powerful in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It may also be successful 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 mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. 144 Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States recommends antiretrovirals in individuals of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is started it is recommended that it is continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desired result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is effective are initially recommended after four weeks and once levels fall below 50copies/mL tests every three to six months are usually adequate. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of folks during the first year. 27

Advantages of treatment contain a reduced risk of progression to AIDS and also a decreased risk of death. Std test closest to Waynesville Illinois. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a reduced danger of transmission to sexual partners of the disease and a reduction in mother-to-child transmission. The effectiveness of treatment depends to a big 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 complexity of treatment regimens (due to pill numbers and dosing frequency) and adverse effects may reduce adherence. 151 Even though price is an important problem with some medicines, 152 47% of those who wanted they were being taken by them in middle and low income nations as of 2010 143 as well as the speed of adherence is similar in low-income and high-income nations. 153

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