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The first 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 continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms at first, close to the end of the period a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , characterized 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 me South Gardiner Maine. South Gardiner ME 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 small percentage (about 5%) retain high amounts 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 those who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 infected individuals. South Gardiner, 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 incidence of specific disorders in association with an HIV infection. Std Test nearby South Gardiner 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 common first conditions that alert 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 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that 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 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 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 majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, 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 public 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 homosexual and bisexual guys have HIV. 49 50 Std Test closest to South Gardiner.

With regard to unprotected heterosexual contacts, estimates 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 countries, 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 states are 0.04% per act for female to male transmission, and 0.08% per act for male-to-female transmission. 51 The risk of transmission from anal intercourse is especially 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 relatively low, it is still present. 53 The danger from getting oral sex was described as "almost nil"; 54 nonetheless, a couple instances are 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 action and male to female transmission as 0.05% per act. 51

The next most common 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 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 near me ME, United States. 63 The risk of getting HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to infected 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 64, 2009 and in some areas more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the risk 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 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 due to screening, it is possible 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 causing infection in the infant. 73 74 This is the third most common manner in which HIV is transmitted globally. 11 In the lack of treatment, the risk 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 can be reduced to about 1%. 73 Preventative treatment involves the mom 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 decline the danger of transmission in people who do breastfeed. 76 Many of these measures are however not obtainable in the developing world. 75 If blood contaminates food during pre- it may pose a risk of transmission. 71

HIV is an associate 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 illnesses with a lengthy 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 resultant 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, allowing the virus and its host cell to avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, creating viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle anew and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel courses: 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 for cell-to-cell spread. Std Test nearby South Gardiner Maine. 86 87 The hybrid dispersing mechanics of HIV lead to the ongoing replication of the virus against antiretroviral therapies. 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 reaction is accompanied by a marked fall in the amount of circulating CD4 T cells. The acute viremia is almost always related to activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody generation, or seroconversion The CD8 T cell response is considered to be important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't eliminate the virus a great CD8 T cell response has been linked to 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 infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the long-term and acute 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 phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decrease in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency feature of AIDS don't appear for a long time after an individual is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, especially during the very first weeks of illness. 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 just a little 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 disease and seeks out. 98 A vigorous immune response begins the clinically latent stage and eventually controls the infection. CD4 T cells in mucosal tissues stay especially impacted. 98 Constant HIV replication causes a state of generalized immune activation lasting throughout the long-term phase. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products as well as the immune response to ongoing HIV replication. Additionally it is 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

South Gardiner, ME Std Test. HIV/AIDS is diagnosed via laboratory 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 people 15years to 65years of age including all pregnant women. 101 Also, testing is suggested for those at high risk, which comprises anyone. 27 In many sections of the planet, a third of HIV carriers just discover when acute immunodeficiency or AIDS has become clear, they're infected at an advanced stage of the disease. Std Test near South Gardiner, ME. 27

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Antibody evaluations in children younger than 18months are generally wrong due to the continuing existence of maternal antibodies 102 Thus 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 reliable PCR testing and a lot of areas just wait until either symptoms grow or the kid is old enough for exact antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. South Gardiner 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 main clinical staging systems are used to classify HIV and HIV-related disorder for surveillance goals: the WHO disorder 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 often adopted in developed nations. Since the WHO 's staging system doesn't need lab tests, it's satisfied to the resource-restricted conditions seen in developing countries, where it can be utilized to help direct clinical management. Despite their differences, the two systems allow 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 individual is infected, the rate of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may provide an equal degree of protection. Std test closest to South Gardiner. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by approximately 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise 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, both UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female-to-male HIV transmission in 2007 in regions using a high rates of HIV. 112 Nevertheless, whether it shields against male to female transmission is disputed, 113 114 and whether it is of advantage 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 option with men who have sex with men. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, hence negating its prophylactic effects. 119

Plans supporting sexual abstinence don't seem to change subsequent HIV risk. 120 Signs of any benefit from peer education is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A substantial 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 nearby ME, United States. 123 Voluntary counselling and testing people for HIV will not influence dangerous behaviour 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 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 disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearby South Gardiner 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 successful 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 may also be effective in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is commonly 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

United States and the World Health Organization urges antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started 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 desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to determine if treatment is powerful are initially urged after four weeks and once degrees fall below 50copies/mL checks every three to six months are usually sufficient. 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 first year. 27

Advantages of treatment contain a decreased risk of death and also a decreased risk of progression to AIDS. Std Test closest to South Gardiner, Maine. Mental and physical health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a decreased risk of transmission to sexual partners of the illness as well as a drop in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on compliance. 27 Reasons 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 problem with some medicines, 152 47% of those who desired them were taking them in the speed of adherence and low and middle income nations as of 2010 143 is comparable in low income and high income nations. 153

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