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The initial symptoms are followed by a stage called asymptomatic HIV clinical latency, or chronic HIV. 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 usually there are no or few symptoms initially, close to the end of this phase lots of people experience fever, weight loss, gastrointestinal problems 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 crotch) for over three to six months. Std Test closest to Old Orchard Beach, Maine. Old Orchard Beach ME 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 tiny proportion (about 5%) retain 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 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 "elite controllers" or "elite suppressors". They represent around 1 in 300 individuals that are infected. Old Orchard Beach, 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 diseases in association with an HIV disease. Std test nearest Old Orchard Beach Maine, United States. 26 In the lack of specific 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

People with AIDS have an increased 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 typical 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 with AIDS and is the initial sign of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more often 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 and also 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this specific people 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 gay and bisexual men have HIV. 49 50 Std test nearby Old Orchard Beach.

With regard to unprotected heterosexual contacts, estimates 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 nations. 51 In low income countries, the danger of female-to-male transmission is estimated as 0.38% per action, 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 action for male to female transmission. 51 The danger of transmission from anal intercourse is especially high, estimated as 1.4-1.7% per act in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is relatively low, it is still present. 53 The danger from receiving oral sex has been described as "virtually nil"; 54 yet, a couple cases are 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 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 injections with unsterilized equipment. The threat from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test near ME 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 action and the threat following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in a few regions 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 countries 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 threat 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 nearby ME, United States. 11 68 Although rare because of screening, it really is likely to get HIV from organ and tissue transplantation 69

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HIV could 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 internationally. 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 proper treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment involves the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, averting breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the risk of transmission in those who do breastfeed. 76 Many of these measures are nevertheless not obtainable in the developing world. 75 If blood contaminates food during pre- chewing it might present a danger of transmission. 71

HIV is an associate 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 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 is transported together with the viral genome in the virus particle. The consequent viral DNA is subsequently 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 the virus and its host cell to prevent detection by the immune system. 83 Alternatively, the virus could 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 anew. 84

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HIV is now understood to disperse between CD4 T cells by two parallel routes: cell free spread and cell-to-cell spread, i.e. it applies crossed 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 may also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test nearest Old Orchard Beach Maine. 86 87 The hybrid dispersing mechanics of HIV lead to the virus's on-going replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, resulting in plenty of virus in the peripheral blood, after 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 marked drop in the number of circulating CD4 T cells. The acute viremia is almost invariably related to activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell response is thought to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't eliminate the virus a good CD8 T cell response was associated with slower disease progression along with a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight illnesses or kill cells that are cancerous. 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 may also be a factor. During the chronic period, the effects 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

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for many years after an individual is infected, the bulk of CD4 T cell loss occurs during the very first weeks of infection, especially 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 most mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas only 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 infection. 98 A vigorous immune response begins the clinically latent period and controls the infection. CD4 T cells in mucosal tissues stay particularly changed. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term phase. 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 and several HIV gene products to ongoing HIV replication. Additionally it is linked to the breakdown 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

Old Orchard Beach, ME Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the presence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Moreover, testing is recommended for those at high risk, which comprises anyone. 27 In many regions of the planet, a third of HIV carriers just discover they're infected at an advanced phase of the disease when AIDS or severe immunodeficiency has become clear. Std Test near me Old Orchard Beach, ME. 27

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Antibody tests in kids younger than 18months are normally wrong due to the ongoing existence of maternal antibodies 102 So 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 a lot of areas simply wait the kid is old enough for antibody testing that is exact or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Old Orchard Beach Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which signified a significant 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 disorder 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 embraced in developed countries. Since the WHO 's staging system doesn't need laboratory tests, it is satisfied to the resource-restricted states seen in developing countries, where it may 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 risk 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 suggest that female condoms may offer an equivalent degree of protection. Std test near me Old Orchard Beach. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce 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 UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female to male HIV transmission in places using a high rates of HIV in 2007. 112 Yet, whether it shields 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, however, does that it be discussed as an alternative with men who have sex with men and recommend for all sexually active heterosexual males. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, hence negating its preventative effects. 119

Plans encouraging sexual abstinence do not appear to change subsequent HIV danger. 120 Evidence of any benefit from peer instruction is equally poor. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A considerable minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test near ME United States. 123 Voluntary counseling and testing individuals for HIV will not affect dangerous behavior in those who test negative but does raise condom use in individuals who test positive. 124 It is not 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 a very effective way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Old Orchard Beach Maine, United States. 125 TASP is related to a 10 to 20 fold decrease 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 youthful heterosexuals in Africa. 109 It might also be effective in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially treatment is generally a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in people 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 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 determine if treatment is effective are initially urged after four weeks and once amounts drop below 50copies/mL checks every three to six months are usually adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is successful in more than 95% of individuals during the first year. 27

Benefits of treatment contain a reduced risk of departure and a decreased risk of progression to AIDS. Std Test closest to Old Orchard Beach Maine. 147 In the developing world treatment also improves mental and physical health. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a reduced danger of transmission of the illness to sexual partners and also a decrease in mother-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 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 though price is an important problem with some medications, 152 47% of those who needed them were taking them in the rate of adherence as well as low and middle income countries as of 2010 143 is comparable in low income and high income states. 153

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