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The first symptoms are followed by a stage called long-term HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV disease can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are no or few symptoms at first, close to the end of this stage many people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test near me Washington, Kansas. Washington, 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 proportion (about 5%) keep elevated amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV accountants or long term nonprogressors (LTNP). 31 Another group consists of those who maintain a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent approximately 1 in 300 contaminated individuals. Washington 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 diseases in association with an HIV disease. Std test nearby Washington Kansas United States. 26 In the lack of particular treatment, around half of individuals 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 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 common cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of almost 16% of individuals with AIDS and is the first signal of AIDS in 3 to 4%. 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 inner part of eyelids as well as 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 individual. 11 The majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this specific population 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 in Washington.

With regard to unprotected heterosexual contacts, approximations of the danger 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 countries, the threat of female-to-male transmission is estimated as 0.38% per action, and of male to female transmission as 0.30% per act; 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 particularly high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it is still present. 53 The risk from getting oral sex has been described as "virtually nil"; 54 yet, a couple instances 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 action and male-to-female transmission as 0.05% per act. 51

The next 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 act, with an average of 0.8%. Std test nearby KS United States. 63 The risk 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 danger 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 64 2009 and in certain regions 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 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'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 nearest KS, United States. 11 68 Although rare due to screening, it really is likely to get 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 resulting in 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, 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 Preventive 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 either the mother or the infant decrease 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- it might introduce a risk of transmission. 71

HIV is a part 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 responsible for long-duration illnesses 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 (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 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 its own host cell and the virus to prevent detection by the immune system. 83 Instead, the virus might be transcribed, creating new RNA genomes and viral proteins that are packaged and released from the cell as new virus particles that start the replication cycle afresh. 84

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HIV is now understood to spread between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it applies hybrid spreading 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 nearest Washington, Kansas. 86 87 The hybrid distributing mechanics of HIV lead to the virus's ongoing replication against antiretroviral therapies. 85 88

There's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood following the virus enters the body. During primary infection, the level 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 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 great CD8 T cell response was associated with a better prognosis along with slower disease progression, though it will not remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are crucial 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 chronic 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 factor. During the chronic stage, the consequences 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 decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for many years after an individual is infected, the majority of CD4 T cell loss happens during the first weeks of disease, 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 access the cells, whereas just a little 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 illness. The disease is eventually controlled by 98 A vigorous immune response and initiates the clinically latent stage. CD4 T cells in mucosal tissues stay especially affected. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term stage. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products as well as the immune response to HIV replication that is continuing. It's also 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

Washington, KS std test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence of certain 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 Also, testing is suggested for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the planet, a third of HIV carriers just discover they're infected at an advanced period of the disease when acute immunodeficiency or AIDS is now apparent. Std Test near me Washington, KS. 27

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Antibody evaluations in kids younger than 18months are generally inaccurate because of the ongoing existence of maternal antibodies 102 Thus 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 simply wait the kid is old enough for exact antibody testing or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Washington std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were tested 103 which signified a substantial increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related disease for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 along with the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently embraced in developed countries. Since the WHO 's staging system doesn't require laboratory tests, it's satisfied to the resource-controlled 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 danger 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 is some evidence to imply that female condoms may provide an equal level of protection. Std Test closest to Washington. 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 tendency to cause vaginal and rectal 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female to male HIV transmission in regions with a high rates of HIV in 2007. 112 Nevertheless, whether it protects against male to female transmission is challenged, 113 114 and whether it is of advantage 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 recommend for all sexually active heterosexual males. 118 Some experts fear that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behaviour, thereby negating its preventative effects. 119

Plans supporting sexual abstinence do not appear to affect subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally poor. 121 Complete sexual education provided at school may fall high risk behavior. 122 A sizeable minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std test nearby KS United States. 123 Voluntary counseling and testing individuals for HIV will not change high-risk behaviour in those who test negative but does increase condom use in individuals who test positive. 124 It isn't understood 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 infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test near me Washington Kansas United States. 125 TASP is associated with a 10 to 20 fold decrease 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 youthful heterosexuals in Africa. 109 It may also be successful in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixtures (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially therapy is commonly 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 including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization advocates antiretrovirals in individuals of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is started it's recommended that it is continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to find out if treatment is successful are initially advocated after four weeks and once levels fall below 50copies/mL tests every three to six months are typically sufficient. 27 Inadequate 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 decreased risk of progression to AIDS and also a reduced danger of death. Std Test nearest Washington Kansas. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced danger of transmission to sexual partners of the disease as well as a drop in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on compliance. 27 Reasons for non-adherence include poor access to medical care, 149 insufficient 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 issue with some medicines, 152 47% of those who needed they were being taken by them in the speed of adherence as well as middle and low income nations as of 2010 143 is comparable in low income and high income countries. 153

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