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The initial symptoms are followed by a period called asymptomatic HIV clinical latency, or persistent HIV. 1 Without treatment, this second stage 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 no or few symptoms at first, near the end of this period a lot of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , characterized 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 nearby Clarksburg, Maryland. Clarksburg MD 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 little proportion (about 5%) keep high amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV controllers 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 contaminated persons. Clarksburg, Maryland 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 in Clarksburg Maryland, United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alarm to the existence 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

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 frequent cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, which is the first hint of AIDS in 3 to 4% and is the cause of death of nearly 16% of individuals with AIDS. 35 Both these cancers are associated 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 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 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 yet, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in the USA occurred among men who had sex with men, with this particular 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 guys have HIV. 49 50 Std test near me Clarksburg.

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 countries. 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 action; 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 danger 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 comparatively low, it's still present. 53 The risk from receiving oral sex has been described as "almost nil"; 54 yet, a couple 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 was estimated as 2.4% per action and male-to-female transmission as 0.05% per action. 51

The second most frequent 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 injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test nearby MD United States. 63 The danger of getting 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 contaminated blood as 0.09% (about 1 in 1000) per action. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the risk 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 example, in the united kingdom 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 is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test in MD, United States. 11 68 Although rare due to screening, it will be possible to acquire HIV from organ and tissue 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 internationally. 11 In the lack 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 Preventative treatment includes 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 either the mother or the infant decline the danger of transmission in people who do breastfeed. Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- chewing it may pose 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 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 entry 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 resultant 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 Instead, the virus could be transcribed, creating viral proteins which 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 understood to disperse between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it employs 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 closest to Clarksburg Maryland. 86 87 The hybrid spreading mechanics of HIV lead to the virus's ongoing replication against antiretroviral treatments. 85 88

Following the virus enters the body there is a period of rapid viral replication, resulting in plenty of virus in the peripheral blood. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a marked fall in the number of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell reaction is believed to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it will not eliminate the virus a good CD8 T cell response has been linked to slower disease progression along with a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are crucial to the immune response and without them, the body cannot fight infections or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and chronic stages. 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 stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency feature of AIDS don't appear for years after an individual is infected, the majority of CD4 T cell loss happens during the first weeks of disease, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body. 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 access the cells, whereas merely a small 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 infection and seeks out. The disease is eventually controlled by 98 A vigorous immune response and initiates the latent phase. CD4 T cells in mucosal tissues remain especially affected. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the long-term stage. 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 several HIV gene products as well as the immune response to continuing HIV replication. It's also 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

Clarksburg MD 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 people 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone. 27 In many sections of the planet, a third of HIV carriers only find they are infected at an advanced phase of the disorder when AIDS or severe immunodeficiency has become clear. Std Test nearest Clarksburg, MD. 27

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Antibody tests in kids younger than 18months are normally erroneous because of the continuing presence 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 several areas simply 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 people were informed of their HIV status. Clarksburg Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan countries were tested 103 which represented a considerable increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related disease for surveillance goals: 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 often embraced in developed countries. Since the WHO 's staging system doesn't need laboratory evaluations, it is suited to the resource-restricted states seen in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems allow 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 rate 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 near Clarksburg. 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 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, both the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female-to-male HIV transmission in areas with a high rates of HIV in 2007. 112 However, whether it protects against male-to-female transmission is questioned, 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, nevertheless, does that it be discussed with men who have sex with men as an alternative and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower perception of exposure among circumcised men may cause more sexual risk taking behavior, thereby negating its prophylactic effects. 119

Plans encouraging sexual abstinence don't seem to affect subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally inferior. High risk behavior may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people proceeds to engage in high risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std test near me MD United States. 123 Voluntary counselling and testing individuals for HIV does not affect 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 effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is quite an productive method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test near Clarksburg Maryland United States. 125 TASP is connected with a 10 to 20 fold decrease in transmission risk. 125 126 Pre-exposure prophylaxis (homework) with a daily dose of the medications tenofovir , with or without emtricitabine , is effective in several 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 using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

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

United States and the World Health Organization recommends antiretrovirals in individuals 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's advised that it's 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 recommended after four weeks and once amounts drop below 50copies/mL tests every three to six months are generally 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 folks during the first year. 27

Advantages of treatment contain a decreased risk of departure and a decreased risk of progression to AIDS. Std test in Clarksburg Maryland. Mental and physical health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased danger of transmission to sexual partners of the disease and a reduction in mother-to-child transmission. The effectiveness of treatment depends to a big 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 though cost is an important issue with some drugs, 152 47% of people who wanted they were being taken by them in middle and low income countries as of 2010 143 and also the rate of adherence is similar in low-income and high income nations. 153

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