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The initial symptoms are followed by a period called long-term HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV disease can continue 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, near the end of this stage lots of people experience gastrointestinal problems, weight loss, fever 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 groin) for over three to six months. Std test closest to Gambrills Maryland. Gambrills MD std test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a little proportion (about 5%) keep elevated levels 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 those who keep a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent about 1 in 300 contaminated persons. Gambrills, 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 occurrence of specific diseases in association with an HIV disease. Std test in Gambrills Maryland, United States. 26 In the lack of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common first conditions that alarm 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

Individuals 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, which is the initial signal of AIDS in 3 to 4% and is the cause of death of almost 16% of people who have AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in those with AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids as well as the white part of the eye) is also more common in those with HIV. 36

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The most frequent 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 nevertheless, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular population 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 bisexual and homosexual men have HIV. 49 50 Std Test in Gambrills.

With regard to unprotected heterosexual contacts, approximations 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 states. 51 In low-income countries, the threat of female-to-male transmission is estimated as 0.38% per action, 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 act for male to female transmission. 51 The risk of transmission from anal intercourse is particularly high, estimated as 1.4-1.7% per action in both heterosexual and homosexual contacts. 51 52 While the danger of transmission from oral sex is relatively low, it's still present. 53 The danger from getting oral sex has been 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 intercourse. 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 action. 51

The 2nd most common way of HIV transmission is via blood and blood products. 11 Blood-borne transmission can be through needle-sharing during intravenous drug use, needle stick injury, transfusion of contaminated blood or blood product, or medical shots 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 nearest MD 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 risk following mucous membrane exposure to infected 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 some places more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the danger of getting 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 danger 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 places 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 because of screening, it really is 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 causing infection in the baby. 73 74 This is the third most common manner in which HIV is transmitted globally. 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 proper treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Preventative treatment includes the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the baby decrease the danger of transmission in those who do breastfeed. Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it may present 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically in charge of long-duration illnesses with 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's transported together with the viral genome in the virus particle. The consequent 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 avoid detection by the immune system. 83 Alternatively, the virus might be transcribed, creating viral proteins that are packaged and released from the cell as new virus particles that start the replication cycle over and new RNA genomes. 84

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HIV is now understood to spread between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it applies crossed propagating 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 process of cell-to-cell spread. Std test near Gambrills, Maryland. 86 87 The hybrid dispersing mechanics of HIV contribute 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 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 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 later with antibody generation, or seroconversion The CD8 T cell reaction is thought to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was linked to slower disease progression and also a better prognosis, though it doesn't get rid of the virus. 92

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

Although the symptoms of immune deficiency characteristic of AIDS don't appear for many years after an individual is infected, the majority of CD4 T cell loss occurs in the intestinal mucosa, which harbors nearly all the lymphocytes found in the body, especially during the first weeks of disease. 95 The reason behind the preferential loss of mucosal CD4 T cells is that the majority of mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas merely 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. The disease is eventually controlled by 98 A vigorous immune response and starts the clinically latent stage. CD4 T cells in mucosal tissues stay particularly impacted. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the long-term period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of the immune response as well as several HIV gene products to ongoing HIV replication. It's also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Gambrills MD std test. HIV/AIDS is diagnosed via lab testing and then staged based on the presence of certain signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers just discover when AIDS or severe immunodeficiency is now evident they're infected at an advanced period of the disorder. Std test near me Gambrills MD. 27

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Antibody tests in children younger than 18months are normally erroneous because of the ongoing existence of maternal antibodies 102 Hence 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 trusted PCR testing and lots of places just wait the kid is old enough for accurate antibody testing 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. Gambrills 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 main clinical staging systems are used to classify HIV and HIV-related ailment for surveillance goals: the WHO disease 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 embraced in developed countries. Since the WHO 's staging system doesn't require lab evaluations, it is suited to the resource-controlled states encountered in developing countries, where it can also be used to help direct clinical management. Despite their differences, both systems permit 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 speed of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may offer an equivalent degree of protection. Std test near Gambrills. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears 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 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 UNAIDS and the World Health Organization advocated male circumcision as a way of preventing female-to-male HIV transmission in areas with a high rates of HIV in 2007. 112 Nevertheless, 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, 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 fear that a lower understanding of exposure among circumcised men may cause more sexual risk taking behavior, thus negating its prophylactic effects. 119

Plans supporting sexual abstinence do not seem to impact subsequent HIV danger. 120 Signs of any benefit from peer education is equally poor. 121 Complete sexual education provided at school may fall high risk behavior. 122 A significant minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std test in MD, United States. 123 Voluntary counseling and testing people for HIV will not influence 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 successful in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is an extremely effective method to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test closest to Gambrills Maryland United States. 125 TASP is connected with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the drugs tenofovir , with or without emtricitabine , is successful in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It might also be successful in intravenous drug users with a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "categories," 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 Mixtures 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 as soon as the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is started it is recommended that it's continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is successful are initially advocated after four weeks and once levels drop 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 standards treatment is effective in more than 95% of individuals during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS and a decreased risk of death. Std Test nearest Gambrills, Maryland. 147 In the developing world treatment also improves mental and physical health. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a reduced danger of transmission to sexual partners of the disease as well as a decrease in mother-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Motives 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 Even though cost is an important issue with some medications, 152 47% of people who needed them were taking them in the speed of adherence as well as middle and low income countries as of 2010 143 is similar in low income and high-income nations. 153

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