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The initial symptoms are followed by a period called clinical latency, asymptomatic HIV, or continual HIV. 1 Without treatment, this second period of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms in the beginning, near the end of the phase lots 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 in Aurora Kansas. Aurora, KS 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 percentage (about 5%) retain elevated amounts 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. Aurora Kansas 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 closest to Aurora Kansas United States. 26 In the absence of specific 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 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 people with HIV. 35 The second most common cancer is lymphoma, which is the initial indication of AIDS in 3 to 4% and is the cause of death of almost 16% of people with AIDS. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often in people that have 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 part 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 however, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this 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 guys have HIV. 49 50 Std Test near me Aurora.

With regard to unprotected heterosexual contacts, approximations of the risk of HIV transmission per sexual act appear to be four to ten times higher in low income countries than in high income states. 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 action; the equivalent estimates 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 action in both heterosexual and homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it is still present. 53 The danger from getting oral sex was described as "virtually nil"; 54 nonetheless, a few 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 action. 51

The second most frequent 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 injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test near me KS 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 action and the threat 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 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 risk 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 suitably screened (as of 2008), 67 and it's 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 diseases. Std test in KS United States. 11 68 Although rare because of screening, it will be likely to acquire 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 baby. 73 74 This is the third most common way in which HIV is transmitted worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals 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 can be reduced to about 1%. 73 Preventative treatment includes the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant 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 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 responsible for long-duration sicknesses using a long 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 along with the viral genome in the virus particle. The resultant viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once incorporated, the virus may become latent, enabling the virus and its own host cell to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins that are packaged and released from the cell as new virus particles that begin the replication cycle anew and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it employs crossed 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 process of cell-to-cell spread. Std test near Aurora Kansas. 86 87 The hybrid distributing mechanics of HIV lead to the continuing replication of the virus against antiretroviral therapies. 85 88

After the virus enters the body there is a period of rapid viral replication, leading to plenty 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 number of circulating CD4 T cells. The acute viremia is almost always related to activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell response is believed to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been associated with slower disease progression along with a better prognosis, though it doesn't get rid of the virus. 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 crucial to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. 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 might also be a factor. During the chronic stage, 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

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for years after an individual is infected, the majority of CD4 T cell loss happens during the first weeks of illness, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body. 95 The reason behind 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 gain access to the cells, whereas just 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 illness and seeks out. The infection is eventually controlled by 98 A vigorous immune response and initiates the latent stage. CD4 T cells in mucosal tissues stay especially affected. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic stage. 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. Additionally it is linked to the dysfunction 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

Aurora, KS Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of particular 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 Additionally, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many regions of the planet, a third of HIV carriers simply find when severe immunodeficiency or AIDS has become apparent they are infected at an advanced period of the disease. Std Test nearest Aurora KS. 27

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Antibody evaluations in kids younger than 18months are generally wrong due to the continuing presence of maternal antibodies 102 Hence HIV infection 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 trusted PCR testing and several 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 inhabitants were aware of their HIV status. Aurora Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were examined 103 which signified a significant increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated 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 embraced in developed nations. Since the WHO 's staging system doesn't require laboratory tests, it's satisfied to the resource-restricted conditions seen in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems permit comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger of HIV transmission by about 80% over the long term. 106 When condoms are used consistently 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 offer an equivalent degree of protection. Std Test nearest Aurora. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears 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 because of its propensity 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female to male HIV transmission in 2007 in areas with a high rates of HIV. 112 Nonetheless, whether it protects against male-to-female transmission is contested, 113 114 and whether it is of benefit 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 advocate for all sexually active heterosexual males. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, thus negating its preventive effects. 119

Programs supporting sexual abstinence do not seem to impact subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally poor. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A large 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 nearest KS, United States. 123 Voluntary counseling and testing individuals for HIV doesn't change dangerous behavior in those who test negative but does raise condom use in those who test positive. 124 It isn't understood whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an productive method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test near Aurora Kansas 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 successful 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

Current HAART alternatives are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "groups," 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 recommends antiretrovirals in individuals of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is started it is advised that it's continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have started. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially recommended after four weeks and once amounts drop below 50copies/mL tests every three to six months are generally 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 individuals during the very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS and a decreased danger of departure. Std Test nearby Aurora Kansas. Physical and mental health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a reduced danger of transmission of the disease to sexual partners as well as a reduction in mom-to-child transmission. The effectiveness of treatment depends to a big 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 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 medicines, 152 47% of those who needed they were being taken by them in low and middle income countries as of 2010 143 and the rate of adherence is comparable in low-income and high income states. 153

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