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The initial symptoms are followed by a stage called clinical latency, asymptomatic HIV, or chronic HIV. 1 Without treatment, this second stage of the natural history of HIV infection can last from around three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are few or no symptoms at first, close to the end of this stage a lot of people experience weight loss, fever, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also develop 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 near Bernard, Maine. Bernard ME 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 tiny percentage (about 5%) keep elevated rates 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 people who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent around 1 in 300 individuals that are contaminated. Bernard, Maine 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 occurrence of specific disorders in association with an HIV infection. Std test nearby Bernard Maine United States. 26 In the lack of special 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 form of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

People 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, that is the cause of death of nearly 16% of people who have AIDS and is the first sign of AIDS in 3 to 4%. 35 Both these cancers are linked 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 inner part of eyelids and 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 person. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, with this particular 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 gay and bisexual men have HIV. 49 50 Std test nearest Bernard.

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 states. 51 In low income nations, the threat 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 nations are 0.04% per action 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 act in both heterosexual and homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The danger from getting oral sex was described as "almost nil"; 54 nonetheless, a few instances are 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 second 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 infected 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 near ME 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 action and the risk following mucous membrane exposure to contaminated 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 2009, 64 and in a few places 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 countries the risk of acquiring 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 instance, in the UK the risk 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 is estimated that up to 15% of HIV infections in these places come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test near ME United States. 11 68 Although rare because of screening, it will be likely 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 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 risk of transmission before or during birth is around 20% and in individuals 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 danger of mother-to-child infection may be reduced to about 1%. 73 Prophylactic treatment involves the mother administering antiretroviral drugs to the newborn, avoiding breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the baby decrease the danger of transmission in those who do breastfeed. Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it might present a threat of transmission. 71

HIV is a part of the genus Lentivirus , 79 part of the family Retroviridae 80 Lentiviruses share many morphological and biological features. Many species of mammals are infected by lentiviruses, which are characteristically accountable for long-duration sicknesses 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 (turn 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 then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once incorporated, the virus may become latent, enabling its particular host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, creating new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle over. 84

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HIV is now understood to spread between CD4 T cells by two parallel routes: 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 after which 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 near me Bernard, Maine. 86 87 The hybrid spreading mechanics of HIV lead to the continuing replication of the virus against antiretroviral therapies. 85 88

There is a period of rapid viral replication, leading to an abundance of virus in the peripheral blood after 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 noticeable drop in the amount of circulating CD4 T cells. The acute viremia is nearly 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 regarded as significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was associated with slower disease progression along with a better prognosis, though it doesn't eliminate the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are crucial to the immune response and weakens the immune system 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 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 might also be a variable. During the chronic stage, the results 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

While the symptoms of immune deficiency feature of AIDS do not appear for many years after a person is infected, the bulk of CD4 T cell loss occurs during the very first weeks of disease, especially in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body. 95 The reason behind the preferential loss of mucosal CD4 T cells is that nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to 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 disease. 98 A vigorous immune response eventually controls the infection and begins the latent period. CD4 T cells in mucosal tissues remain particularly changed. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term period. 99 Immune activation, which is represented by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the action of several HIV gene products and the immune response 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

Bernard, ME std test. HIV/AIDS is diagnosed via laboratory 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 Additionally, testing is recommended for those at high risk, which comprises anyone. 27 In many areas of the world, a third of HIV carriers simply find they are infected at an advanced stage of the disease when AIDS or severe immunodeficiency is now obvious. Std Test near me Bernard, ME. 27

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Antibody evaluations in kids younger than 18months are typically inaccurate because of the continuing existence 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 several places simply 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 people were aware of their HIV status. Bernard Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were examined 103 which represented a significant increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance purposes: the WHO disorder staging system for HIV infection and disease , 24 and 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 need laboratory 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 enable comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 80% over the long term. 106 When condoms are used consistently 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 offer an equal level of protection. Std test near me Bernard. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems 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 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 UNAIDS and the World Health Organization advocated male circumcision as a way of preventing female to male HIV transmission in 2007 in regions with a high rates of HIV. 112 However, whether it shields against male-to-female transmission is contested, 113 114 and whether it's of advantage in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does that it be discussed as an option with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk taking behavior, thus negating its preventative effects. 119

Programs encouraging sexual abstinence don't seem to influence subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people continues to engage in high risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearby ME United States. 123 Voluntary counseling and testing people for HIV does not change dangerous behavior in individuals who test negative but does raise condom use in individuals who test positive. 124 It is not 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 an extremely effective way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std Test near me Bernard Maine United States. 125 TASP is connected with 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 successful 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 successful in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are blends (or "cocktails") consisting of at least three drugs 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 Blends of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have begun. 27 The desired result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is effective are initially urged after four weeks and once degrees fall 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 criteria treatment is successful in more than 95% of people during the very first year. 27

Benefits of treatment contain a decreased risk of progression to AIDS as well as a decreased risk of departure. Std test nearby Bernard Maine. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased risk of transmission of the disease to sexual partners and also a decrease in mom-to-child transmission. The effectiveness of treatment depends to a large 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 though cost is an important problem with some medications, 152 47% of people who wanted they were being taken by them in middle and low income countries as of 2010 143 and the speed of adherence is similar in low income and high-income nations. 153

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