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The first symptoms are followed by a stage called persistent HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second stage 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 usually there are no or few symptoms initially, close to the end of this period many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , defined 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 nearest Oak Ridge, Louisiana. Oak Ridge LA 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 elevated 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 "top-notch suppressors". They represent approximately 1 in 300 infected individuals. Oak Ridge 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 disorders in association with an HIV disease. Std test in Oak Ridge Louisiana, United States. 26 In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alarm to the presence 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 a higher 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 common 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 people who have AIDS and is the initial hint of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 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 globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this population accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of bisexual and homosexual guys have HIV. 49 50 Std Test in Oak Ridge.

With respect to unprotected heterosexual contacts, approximations 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 nations, the danger 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 estimates for high-income countries are 0.04% per act for female-to-male transmission, and 0.08% per action for male-to-female transmission. 51 The risk of transmission from anal intercourse is particularly 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 comparatively low, it is still present. 53 The danger from getting oral sex was 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 has been estimated as 2.4% per act and male-to-female transmission as 0.05% per action. 51

The next most common 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 infected blood or blood product, or medical injections with unsterilized equipment. The danger 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 LA, United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per act and the threat following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In America intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in a few areas more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the risk of getting 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 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 suitably 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 diseases. Std Test nearest LA, United States. 11 68 Although rare due to screening, it is possible to get 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 leading to infection in the baby. 73 74 This is the third most common way in which HIV is transmitted worldwide. 11 In the absence of treatment, the danger 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 appropriate treatment the risk of mother-to-child infection may be reduced to about 1%. 73 Prophylactic treatment involves 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 baby decrease the risk of transmission in people who do breastfeed. 76 Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it might pose 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 responsible for long-duration illnesses using a 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 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 might become latent, enabling the virus and its own host cell to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins which are packaged and discharged from the cell as new virus particles that begin the replication cycle anew and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it uses crossed 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 may also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std test nearby Oak Ridge Louisiana. 86 87 The hybrid distributing mechanics of HIV lead 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, leading to plenty 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 noticeable drop in the amount of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody production, or seroconversion The CD8 T cell response is regarded as important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was associated with a better prognosis as well as slower disease progression, though it does not get rid of the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are essential to the immune response and weakens the immune system and without them, the body cannot fight infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and long-term 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 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 decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency feature of AIDS do not appear for many years after someone is infected, the majority of CD4 T cell loss happens during the 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 the majority of 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 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. 98 A vigorous immune response initiates the clinically latent stage and eventually controls the infection. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the long-term phase. 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 continuing. It is also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier caused by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Oak Ridge LA Std Test. HIV/AIDS is diagnosed via laboratory 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 people 15years to 65years old including all pregnant women. 101 Furthermore, testing is recommended for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many regions of the planet, a third of HIV carriers just discover when AIDS or acute immunodeficiency has become evident, they are infected at an advanced phase of the disorder. Std test near me Oak Ridge LA. 27

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Antibody evaluations in kids younger than 18months are usually inaccurate because of 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 many areas simply wait until either symptoms grow 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 population were aware of their HIV status. Oak Ridge Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were examined 103 which signified a substantial increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance goals: the WHO disease 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 frequently embraced in developed nations. Since the WHO 's staging system doesn't need laboratory tests, it's suited to the resource-controlled states seen in developing countries, where it can be used to help guide clinical management. Despite their differences, both systems enable comparison for statistical purposes. 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 is some evidence to suggest that female condoms may offer an equal level of protection. Std Test closest to Oak Ridge. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears 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 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female-to-male HIV transmission in 2007 in places with a high rates of HIV. 112 Nonetheless, whether it protects against male-to-female transmission is challenged, 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 with men who have sex with men as an alternative and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behavior, thus negating its prophylactic effects. 119

Plans supporting sexual abstinence don't seem to influence subsequent HIV risk. 120 Evidence of any advantage from peer education is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A large minority of young people proceeds to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test closest to LA, United States. 123 Voluntary counselling and testing individuals for HIV does not change dangerous behavior in individuals who test negative but does increase 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 a very effective method to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std test closest to Oak Ridge Louisiana United States. 125 TASP is related to a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications 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 might also be successful in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially therapy is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: 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

The World Health Organization and United States advocates antiretrovirals in individuals 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 is continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have started. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is effective are initially advocated after four weeks and once amounts drop below 50copies/mL checks every three to six months are generally 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 individuals during the very first year. 27

Benefits of treatment include a reduced risk of progression to AIDS and also a reduced risk of death. Std test closest to Oak Ridge, Louisiana. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added benefits include a reduced risk of transmission to sexual partners of the disease and a reduction in mom-to-child transmission. The effectiveness of treatment depends to a large 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 though cost is an important issue 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 rate of adherence is comparable in low-income and high income nations. 153

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