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The initial symptoms are followed by a period called asymptomatic HIV, clinical latency, or chronic HIV. 1 Without treatment, this second period of the natural history of HIV infection can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms initially, 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 crotch) for over three to six months. Std test in Garden City, Louisiana. Garden City LA std test. 2

Although most HIV 1 infected people have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a little percentage (about 5%) keep elevated 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 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 infected persons. Garden City, Louisiana 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 infection. Std test near Garden City Louisiana United States. 26 In the absence of particular treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alert 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

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 frequent cancer occurring in 10 to 20% of individuals 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 initial indication of AIDS in 3 to 4%. 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 inner part of eyelids and also 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 majority 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 nations. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this people accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of homosexual and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std test closest to Garden City.

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 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 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 action 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 danger from receiving oral sex has been described as "almost nil"; 54 yet, a few instances have been 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 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 during intravenous drug use, needle stick injury, transfusion of infected blood or blood product, or medical shots with unsterilized equipment. The risk 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 LA, United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the threat following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some 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 nations 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 appropriately screened (as of 2008), 67 and it's estimated that up to 15% of HIV infections in these places come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std test near me LA, United States. 11 68 Although rare because of screening, it is possible 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 causing infection in the infant. 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 additionally 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 includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decrease the risk of transmission in people 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 risk 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 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 along with the viral genome in the virus particle. The consequent 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 might become latent, enabling its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus could be transcribed, generating viral proteins which are packaged and discharged from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now known to disperse between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it uses hybrid spreading mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid then infect another T cell following a chance encounter. 85 HIV can also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test nearby Garden City Louisiana. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's on-going replication against antiretroviral treatments. 85 88

After the virus enters the body there is a period of rapid viral replication, resulting in 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 response is accompanied by a noticeable fall in the number of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody production, or seroconversion The CD8 T cell response is thought to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it will 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 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 chronic and acute phases. 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 phase, the results 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

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for many years after someone is infected, the majority of CD4 T cell loss happens during the very first weeks of illness, particularly in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body. 95 The reason for 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 obtain access to the cells, whereas merely 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 destroys CCR5 expressing CD4 T cells during acute illness and seeks out. The infection is eventually controlled by 98 A vigorous immune response and begins the latent period. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term stage. 99 Immune activation, which is represented by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of the immune response as well as several HIV gene products to HIV replication that is continuing. It's also 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

Garden City LA 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 of age including all pregnant women. 101 Furthermore, testing is suggested for those at high risk, which includes anyone. 27 In many sections of the world, a third of HIV carriers simply discover when AIDS or acute immunodeficiency has become obvious they are infected at an advanced stage of the disorder. Std test nearest Garden City LA. 27

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Antibody evaluations in kids younger than 18months are commonly wrong due to the continued presence 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 dependable PCR testing and several areas just wait until either symptoms develop or the child is old enough for antibody testing that is precise. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Garden City Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which signified a significant increase compared to preceding years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: the WHO disease 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 adopted in developed countries. Since the WHO 's staging system doesn't require lab evaluations, it's satisfied to the resource-restricted states seen in developing countries, where it can also be used to help direct clinical management. Despite their differences, both systems enable comparison for statistical purposes. 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 individual is infected, the speed of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may provide an equal level of protection. Std Test near Garden City. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female to male HIV transmission in areas with a high rates of HIV in 2007. 112 Nonetheless, whether it shields against male-to-female transmission is contested, 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 as an alternative with men who have sex with men. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behaviour, thereby negating its prophylactic effects. 119

Programs supporting sexual abstinence don't appear to influence subsequent HIV risk. 120 Evidence of any advantage from peer instruction is equally poor. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people continues to participate in high risk practices despite understanding about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std Test near LA, United States. 123 Voluntary counseling and testing people for HIV doesn't change hazardous 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 successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is quite an effective method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test nearby Garden City Louisiana, 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 medications tenofovir , with or without emtricitabine , is powerful in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be successful in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in individuals of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it is advised that it's continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desired result of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is effective are initially recommended after four weeks and once levels drop below 50copies/mL tests every three to six months are generally sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is effective in more than 95% of folks during the very first year. 27

Benefits of treatment include a reduced risk of progression to AIDS as well as a reduced danger of death. Std Test near Garden City Louisiana. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased risk of transmission to sexual partners of the illness and a reduction in mom-to-child transmission. The effectiveness of treatment depends to a big part on conformity. 27 Motives for non-adherence include poor access to medical care, 149 inadequate 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 cost is an important problem with some medicines, 152 47% of people who desired them were taking them in the rate of adherence and middle and low income countries as of 2010 143 is comparable in low-income and high-income countries. 153

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