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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 phase 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 generally there are few or no symptoms at first, near the end of this stage many people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop 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 Robinson, Kansas. Robinson, 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 little percentage (about 5%) retain high rates 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 "elite controllers" or "top-notch suppressors". They represent about 1 in 300 infected persons. Robinson 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 incidence of specific disorders in association with an HIV infection. Std test near me Robinson Kansas, 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 initial 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

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 common cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the first indication of AIDS in 3 to 4% and is the cause of death of nearly 16% of people with AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in people that have AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and the white portion of the eye) is also more common in those with HIV. 36

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The most frequent mode of transmission of HIV is through sexual contact with an infected person. 11 The bulk 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 states. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular 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 near me Robinson.

With regard 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 states. 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 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 act in both heterosexual and homosexual contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex has been described as "virtually nil"; 54 nonetheless, a couple instances 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 mode 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 injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test nearest KS United States. 63 The danger 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 hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few 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 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 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'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 in KS, United States. 11 68 Although rare due to screening, it's possible to acquire HIV from organ and tissue transplantation 69

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HIV could 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 way 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 individuals 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 can be reduced to about 1%. 73 Prophylactic 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 the mother or the baby decline the danger of transmission in people who do breastfeed. Many of these measures are yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it may present a danger 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 with an extended 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 (reverse 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 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 prevent detection by the immune system. 83 Instead, the virus could be transcribed, producing new RNA genomes and viral proteins which are packaged and discharged from the cell as new virus particles that start the replication cycle afresh. 84

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HIV is now known to distribute between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it employs hybrid spreading 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 near me Robinson, Kansas. 86 87 The hybrid spreading mechanics of HIV lead to the on-going replication of the virus against antiretroviral therapies. 85 88

There's 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 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 later with antibody production, or seroconversion The CD8 T cell reaction is considered to be significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it does not remove the virus a great CD8 T cell response was associated with slower disease progression along with a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are essential to the immune response and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the long-term and acute 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 period, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for years after someone is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors most of the lymphocytes found in the body, especially during the 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 merely a small fraction of CD4 T cells in the bloodstream do thus. 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. 98 A vigorous immune response controls the disease and initiates the clinically latent phase. CD4 T cells in mucosal tissues stay especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation continuing 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 several HIV gene products and also the immune response to HIV replication that is ongoing. Additionally it is linked to the breakdown 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

Robinson KS std test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many sections of the planet, a third of HIV carriers simply discover when acute immunodeficiency or AIDS is now evident they're infected at an advanced phase of the disease. Std test near me Robinson KS. 27

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Antibody tests in children younger than 18months are typically inaccurate because of 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 a lot of areas simply wait until either symptoms develop 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 population were informed of their HIV status. Robinson std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were examined 103 which represented a significant increase compared to preceding years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related disorder for surveillance purposes: the WHO disorder staging system for HIV infection and disease , 24 and also 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 does not require laboratory tests, it's satisfied to the resource-restricted states seen in developing countries, where it can also be utilized to help direct 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 person is infected, the rate of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may provide an equal degree of protection. Std test near Robinson. 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 because of its inclination to cause rectal and vaginal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men 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 way of preventing female-to-male HIV transmission in regions with a high rates of HIV in 2007. 112 However, whether it protects against male-to-female transmission is challenged, 113 114 and whether it's of benefit 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 fear that a lower perception of exposure among circumcised men may cause more sexual risk-taking behavior, thus negating its preventive effects. 119

Plans encouraging sexual abstinence don't appear to impact subsequent HIV danger. 120 Signs of any gain from peer instruction is equally poor. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A sizeable minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std test near me KS, United States. 123 Voluntary counseling and testing people for HIV does not influence dangerous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It isn't 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 referred to as treatment as prevention, or TASP). Std Test closest to Robinson Kansas, United States. 125 TASP is related to 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 several 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 danger of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are mixes (or "cocktails") consisting of at least three drugs belonging to at least two kinds, 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 comprise: 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 people of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 After treatment is started it's advised that it is continued without breaks or "holidays". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to find out if treatment is effective are initially urged after four weeks and once levels 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 folks during the first year. 27

Advantages of treatment contain a reduced risk of death and also a reduced risk of progression to AIDS. Std Test in Robinson, Kansas. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased risk of transmission to sexual partners of the illness and a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a large 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 medicines, 152 47% of people who desired they were being taken by them in low and middle income countries as of 2010 143 and the speed of adherence is comparable in low income and high income states. 153

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