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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or continual HIV. 1 Without treatment, this second period of the natural history of HIV infection can continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are few or no symptoms initially, near the end of the period lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , characterized 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 near me Larned Kansas. Larned KS 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 small percentage (about 5%) retain high 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 individuals who maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent around 1 in 300 persons that are infected. Larned 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 Larned Kansas United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common 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

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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the initial signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of individuals with AIDS. 35 Both these cancers are associated 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 interior part of eyelids as well as the white part 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 however, the pattern 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 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 men have HIV while 28 percent of transgender women test positive. 49 50 Std Test closest to Larned.

With respect to unprotected heterosexual contacts, approximations 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 nations. 51 In low-income nations, the risk of female to male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per act; the equivalent approximations 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 especially 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 relatively low, it's still present. 53 The danger from getting oral sex has been 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 has been estimated as 2.4% per act and male-to-female transmission as 0.05% per act. 51

The second 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 closest to 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 act and the danger following mucous membrane exposure to contaminated 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 64 2009 and in some places 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 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 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 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 diseases. Std test near KS United States. 11 68 Although rare due to screening, it will be likely 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 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 those who additionally breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventative treatment involves the mom administering antiretroviral drugs to the newborn, averting breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the infant decrease the danger of transmission in people who do breastfeed. 76 Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it might pose a danger 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 responsible for long-duration sicknesses using a very long 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 (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 consequent viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus might become latent, allowing the virus and its particular host cell to avoid detection by the immune system. 83 Alternatively, the virus might 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 over. 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 crossed propagating mechanisms. 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 closest to Larned, Kansas. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's ongoing replication against antiretroviral therapies. 85 88

There is a period of rapid viral replication, leading to 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 marked fall in the amount of circulating CD4 T cells. The acute viremia is almost invariably related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is regarded as significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was associated with slower disease progression and also 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 weakens the immune system and allows opportunistic infections T cells are critical to the immune response and without them, the body cannot fight diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and long-term 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 might also be a variable. During the chronic period, the results 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

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for decades after a person is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors most 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 nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas only a small 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 infection. The disease is eventually controlled by 98 A vigorous immune response and begins the latent phase. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the chronic phase. 99 Immune activation, which is reflected 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 HIV replication that is continuing. It is also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Larned, KS Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of certain signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many sections of the world, a third of HIV carriers just discover they're infected at an advanced period of the disease when AIDS or acute immunodeficiency has become obvious. Std test near Larned KS. 27

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Antibody tests in children younger than 18months are generally erroneous because of the continuing existence 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 trusted PCR testing and lots of places just wait the kid is old enough for exact antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Larned Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which represented a significant increase compared to previous 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 and the CDC classification system for HIV infection 104 The CDC 's classification system is more often embraced in developed nations. Since the WHO 's staging system does not need lab evaluations, it's satisfied to the resource-restricted states encountered in developing countries, where it can also be utilized to help direct clinical management. Despite their differences, the two systems enable comparison for statistical purposes. 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 rate of HIV infection is less than 1% per year. 107 There's some evidence to suggest that female condoms may offer an equivalent level of protection. Std test in Larned. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission because of 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in 2007 in areas using a high rates of HIV. 112 However, whether it protects against male-to-female transmission is disputed, 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 as an alternative with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behaviour, thereby negating its preventive effects. 119

Plans encouraging sexual abstinence do not seem to affect subsequent HIV risk. 120 Evidence of any gain from peer instruction is equally poor. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A significant minority of young people proceeds to engage 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 individuals for HIV doesn't change dangerous behaviour in individuals 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 successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an productive way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test nearby Larned 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 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 using a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is generally 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 mentioned regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in people of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it is recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desired results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is effective are initially advocated after four weeks and once degrees drop below 50copies/mL checks 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 effective in more than 95% of people during the first year. 27

Benefits of treatment contain a decreased danger of departure and a decreased risk of progression to AIDS. Std Test nearby Larned Kansas. 147 In the developing world treatment also improves mental and physical health. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased danger of transmission of the disease to sexual partners and a reduction in mother-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Motives 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 issue with some medications, 152 47% of those who desired them were taking them in low and middle income countries as of 2010 143 and also the speed of adherence is comparable in low-income and high-income countries. 153

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