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The first symptoms are followed by a stage called chronic HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second stage of the natural history of HIV infection can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms initially, near the end of this period lots of people experience gastrointestinal difficulties, weight loss, fever and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test in Springfield Louisiana. Springfield, LA 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 percentage (about 5%) retain 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 individuals who maintain a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 persons that are contaminated. Springfield 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 infection. Std test near Springfield 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 form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals 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 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 as well as the white part 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 people of the opposite sex); 11 yet, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this specific people 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 gay and bisexual guys have HIV. 49 50 Std test closest to Springfield.

With regard 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 countries. 51 In low income countries, the risk 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 approximations for high-income states are 0.04% per act for female-to-male transmission, and 0.08% per action 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 danger of transmission from oral sex is relatively low, it is still present. 53 The risk from receiving oral sex has been described as "nearly nil"; 54 nonetheless, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings including 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 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 shots 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 nearby 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 act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in certain places more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations 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 united kingdom 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 is estimated that up to 15% of HIV infections in these regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std Test near me LA United States. 11 68 Although rare due to screening, it is possible 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 leading to infection in the infant. 73 74 This is the third most common manner in which HIV is transmitted internationally. 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 danger of mother-to-child infection could be reduced to about 1%. 73 Prophylactic treatment includes the mom preventing 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 infant decline the danger of transmission in those who do breastfeed. Many of these measures are nevertheless not obtainable in the developing world. 75 If blood contaminates food during pre- it may present 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 sicknesses using an extended 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 (turn 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 co-factors. 82 Once incorporated, the virus might become latent, enabling its particular host cell and the virus to prevent detection by the immune system. 83 Instead, the virus could be transcribed, creating viral proteins that are packaged and released 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 known to disperse between CD4 T cells by two parallel routes: cell-free spread and cell-to-cell spread, i.e. it employs hybrid propagating 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 process of cell-to-cell spread. Std Test near Springfield, Louisiana. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's continuing replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood, following the virus enters the body. During primary infection, the amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable 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 later with antibody production, or seroconversion The CD8 T cell reaction is regarded as significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't 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 diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 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 seem to account for the slow decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for years after a person 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 in 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 just a tiny 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 stage. CD4 T cells in mucosal tissues remain especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the chronic period. 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 the immune response and several HIV gene products to HIV replication that is continuing. Additionally it is linked to the breakdown 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

Springfield LA std test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of particular 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 Moreover, 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 simply find they are infected at an advanced phase of the disease when acute immunodeficiency or AIDS is now evident. Std test in Springfield, LA. 27

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Antibody tests in kids younger than 18months are usually erroneous due to the continued presence of maternal antibodies 102 Consequently 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 dependable PCR testing and lots of places just wait the kid is old enough for antibody testing that is precise or until either symptoms develop. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Springfield std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which signified a substantial increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related disorder for surveillance purposes: 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 nations. Since the WHO 's staging system doesn't require lab tests, it's satisfied to the resource-restricted states encountered in developing countries, where it may also be used to help guide clinical management. Despite their differences, both 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 consistently by a couple in which one individual is infected, the speed of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equal level of protection. Std test in Springfield. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission because of 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 UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007 in areas using a high rates of HIV. 112 Nevertheless, whether it shields against male to female transmission is disputed, 113 114 and whether it's of advantage in developed nations 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 advocate 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, hence negating its preventive effects. 119

Programs supporting sexual abstinence don't seem to impact subsequent HIV risk. 120 Signs of any advantage from peer education is equally inferior. 121 Comprehensive sexual education provided at school may decrease high risk behavior. 122 A significant minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std test near me LA United States. 123 Voluntary counselling and testing people for HIV does not change hazardous behavior in individuals who test negative but does increase condom use in individuals who test positive. 124 It is not understood whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is a very effective way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test nearest Springfield Louisiana, United States. 125 TASP is connected 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 a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It may also be successful in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," 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 include: 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 advocates antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is begun it is recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is successful are initially advocated after four weeks and once degrees fall below 50copies/mL tests every three to six months are generally sufficient. 27 Inadequate 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 include a decreased risk of death and also a decreased risk of progression to AIDS. Std Test closest to Springfield Louisiana. Mental and physical health also enhances. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced risk of transmission of the disease to sexual partners and also a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Reasons 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 cost is an important issue with some drugs, 152 47% of people who desired they were being taken by them in the rate of adherence as well as middle and low income countries as of 2010 143 is similar in low income and high-income countries. 153

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