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The first 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 about three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are few or no symptoms in the beginning, close to the end of the period lots of people experience gastrointestinal difficulties, weight loss, fever 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 groin) for over three to six months. Std test in Coolidge Kansas. Coolidge KS 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 tiny proportion (about 5%) keep high levels 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 individuals who keep a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 persons that are contaminated. Coolidge, 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 diseases in association with an HIV disease. Std Test in Coolidge Kansas, United States. 26 In the lack of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common 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 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the first signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of people who have AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in the United States 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. 49 About 15% of gay and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std test near me Coolidge.

With regard to unprotected heterosexual contacts, estimates 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 nations. 51 In low income countries, the danger of female-to-male transmission is estimated as 0.38% per act, and of male to female transmission as 0.30% per action; the equivalent approximations for high-income countries 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 act in both heterosexual and gay 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 yet, a couple cases have been 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 action and male-to-female transmission as 0.05% per act. 51

The second most common mode 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 threat from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test closest to KS, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some areas 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 UK the danger 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 regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test near KS United States. 11 68 Although rare due to screening, it really is likely to acquire HIV from organ and tissue transplantation 69

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HIV may 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 lack of treatment, the risk of transmission before or during birth is around 20% and in people 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 danger of mother-to-child infection can be reduced to about 1%. 73 Preventive treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decrease the risk of transmission in those who do breastfeed. Many of these measures are however not accessible the developing world. 75 If blood contaminates food during pre- chewing it might introduce a danger 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 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 resulting 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 incorporated, the virus might become latent, allowing its own host cell and the virus to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle afresh and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it employs 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 may also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std Test near me Coolidge Kansas. 86 87 The hybrid spreading mechanics of HIV lead to the virus's ongoing 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 amount of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked drop in the number of circulating CD4 T cells. The acute viremia is nearly always related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell reaction is considered to be important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was associated with slower disease progression and a better prognosis, though it will not get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are crucial to the immune response and weakens the immune system and without them, the body cannot fight diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 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

Although the symptoms of immune deficiency feature of AIDS don't appear for many years after someone is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body, particularly during the very first weeks of infection. 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 gain access to the cells, whereas only 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. The infection is eventually controlled by 98 A vigorous immune response and initiates the clinically latent period. CD4 T cells in mucosal tissues stay particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term 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 HIV replication that is ongoing. 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

Coolidge, KS Std Test. HIV/AIDS is diagnosed via lab testing and then staged based on the presence 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 Furthermore, 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 severe immunodeficiency is now apparent they are infected at an advanced period of the disease. Std Test nearby Coolidge KS. 27

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Antibody tests in kids younger than 18months are commonly erroneous due to the continuing presence 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 dependable PCR testing and lots of areas just wait until either symptoms grow or the child is old enough for antibody testing that is exact. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Coolidge Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which represented a considerable increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance goals: 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 often embraced in developed countries. Since the WHO 's staging system does not 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 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 by a couple in which one individual 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 nearby Coolidge. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its inclination 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 the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007 in regions 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 nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does advocate 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 perception of exposure among circumcised men may cause more sexual risk taking behaviour, thus negating its preventive effects. 119

Plans encouraging sexual abstinence do not appear to influence subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally inferior. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A considerable minority of young people continues to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std test in KS, United States. 123 Voluntary counseling and testing people for HIV doesn't affect risky behaviour in individuals who test negative but does raise condom use in individuals who test positive. 124 It is not known 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 referred to as treatment as prevention, or TASP). Std Test nearby Coolidge Kansas 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 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 young heterosexuals in Africa. 109 It may also be effective in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue 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 above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in folks of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it is advised that it is continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is powerful are initially advocated after four weeks and once amounts fall below 50copies/mL tests every three to six months are typically 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 people during the first year. 27

Benefits of treatment include a decreased risk of departure as well as a decreased risk of progression to AIDS. Std test near Coolidge, Kansas. Physical and mental health also improves. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a reduced danger of transmission to sexual partners of the illness as well as a decrease in mother-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 Even though price is an important problem with some medications, 152 47% of those who desired they were being taken by them in middle and low income nations as of 2010 143 and also the speed of adherence is similar in low-income and high income states. 153

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