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The first symptoms are followed by a period called continual HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second period of the natural history of HIV disease 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 in the beginning, 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 individuals also develop 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 near me Wytopitlock Maine. Wytopitlock 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 high rates 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 antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent approximately 1 in 300 persons that are contaminated. Wytopitlock 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 nearest Wytopitlock Maine United States. 26 In the lack 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 type of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals 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 typical 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 nearly 16% of individuals with AIDS and is the first indication of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often 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 also the white part of the eye) is also more prevalent in those with HIV. 36

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The most frequent mode of transmission of HIV is through sexual contact with an infected person. 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 states. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this 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 homosexual and bisexual men have HIV. 49 50 Std Test in Wytopitlock.

With regard to unprotected heterosexual contacts, estimates of the danger 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 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 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 especially 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's still present. 53 The danger from receiving oral sex was described as "almost nil"; 54 however, a couple 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 was 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 shots with unsterilized equipment. The threat from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test nearest ME United States. 63 The danger of getting HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the hazard following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in certain 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 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 united kingdom 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's estimated that up to 15% of HIV infections in these regions come from transfusion of infected 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 tissue and organ 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 infant. 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 individuals who additionally breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment includes the mom avoiding 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 yet not available in the developing world. 75 If food is contaminated by blood during pre- chewing it might introduce 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 features. Many species of mammals are infected by lentiviruses, which are characteristically in charge of long-duration illnesses with a long incubation period 81 Lentiviruses are transmitted as single-stranded, positive- sense , enveloped RNA viruses Upon entry 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 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 might become latent, allowing its particular host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, generating 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 known to distribute between CD4 T cells by two parallel routes: cell free spread and cell-to-cell spread, i.e. it uses crossed propagating 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 of cell-to-cell spread. Std Test in Wytopitlock Maine. 86 87 The hybrid distributing mechanics of HIV contribute to the ongoing replication of the virus against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in plenty of virus in the peripheral blood following 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 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 subsequently with antibody generation, or seroconversion The CD8 T cell reaction is considered to be significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to a better prognosis and slower disease progression, though it doesn't remove 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 diseases or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 phase, the effects 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

Although the symptoms of immune deficiency characteristic of AIDS don't appear for decades after a person is infected, the majority of CD4 T cell loss happens during the first weeks of infection, especially in the intestinal mucosa, which harbors most of 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 merely 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 destroys CCR5 expressing CD4 T cells during acute illness and seeks out. 98 A vigorous immune response controls the infection and initiates the clinically latent phase. CD4 T cells in mucosal tissues remain especially affected. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term period. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of the immune response and also several HIV gene products to continuing HIV replication. It is also 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

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

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Antibody evaluations in kids younger than 18months are typically erroneous due to the ongoing presence of maternal antibodies 102 So 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 several areas simply wait the kid is old enough for antibody testing that is precise or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. Wytopitlock Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were analyzed 103 which represented a substantial increase compared to preceding years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related ailment for surveillance goals: 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 countries. Since the WHO 's staging system doesn't need laboratory tests, it is satisfied to the resource-restricted conditions seen in developing countries, where it may also be utilized to help guide clinical management. Despite their differences, both systems permit 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 speed of HIV infection is less than 1% per year. 107 There's some evidence to suggest that female condoms may offer an equivalent level of protection. Std test in Wytopitlock. 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 increase the risk of transmission because of its tendency to cause rectal and vaginal irritation. 110

Circumcision in Sub-Saharan Africa "reduces the acquisition of HIV by heterosexual men by between 38% and 66% over 24 months". 111 Due to these studies, both UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in 2007 in regions using a high rates of HIV. 112 Nonetheless, whether it shields 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, however, 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 vulnerability among circumcised men may cause more sexual risk taking behavior, hence negating its prophylactic effects. 119

Plans supporting sexual abstinence don't seem to impact subsequent HIV risk. 120 Evidence of any gain from peer education is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A significant minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std Test nearby ME, United States. 123 Voluntary counselling and testing individuals for HIV will not change risky behavior in individuals who test negative but does increase condom use in individuals 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 quite an productive way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test near Wytopitlock 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 a number of groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It might also be effective in intravenous drug users with a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are combinations (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Mixtures of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States recommends antiretrovirals in individuals of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just 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 powerful are initially advocated after four weeks and once levels fall below 50copies/mL checks every three to six months are generally sufficient. 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 first year. 27

Benefits of treatment include a reduced risk of departure and also a decreased risk of progression to AIDS. Std Test nearby Wytopitlock, 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 Additional benefits include a reduced danger of transmission of the disease to sexual partners as well as a drop in mother-to-child transmission. The effectiveness of treatment depends to a large part on conformity. 27 Rationales for non-adherence include poor access to medical care, 149 insufficient 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 price is an important issue with some medicines, 152 47% of those who desired them were taking them in middle and low income countries as of 2010 143 and also the rate of adherence is comparable in low-income and high-income countries. 153

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