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The first symptoms are followed by a stage called asymptomatic HIV clinical latency, or long-term HIV. 1 Without treatment, this second period of the natural history of HIV disease can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms in the beginning, close to the end of the period many 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 greater than one group of lymph nodes (other than in the crotch) for over three to six months. Std Test near me Lutherville Timonium Maryland. Lutherville Timonium 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 small proportion (about 5%) keep high 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 maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 contaminated individuals. Lutherville Timonium, 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 infection. Std test in Lutherville Timonium Maryland, United States. 26 In the lack of special treatment, around half of people 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 form 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 typical 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 signal 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 because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and the white portion 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 yet, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, 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 guys have HIV. 49 50 Std Test in Lutherville Timonium.

With regard to unprotected heterosexual contacts, approximations 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 countries. 51 In low income countries, the risk 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 approximations for high income states 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 particularly 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 is still present. 53 The risk from getting oral sex was described as "virtually nil"; 54 nonetheless, a few cases are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings including 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 next most common mode 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 injections with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test near me 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 danger following mucous membrane exposure to infected 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 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 contaminated blood. 63 In developed nations the danger 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 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 suitably screened (as of 2008), 67 and it's 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 nearest MD United States. 11 68 Although rare due to screening, it really is likely to get HIV from tissue and organ transplantation 69

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HIV may 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 way in which HIV is transmitted globally. 11 In the absence 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 could be reduced to about 1%. 73 Preventative treatment involves the mother administering antiretroviral drugs to the newborn, preventing breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the baby decline the danger of transmission in people who do breastfeed. 76 Many of these measures are nevertheless not obtainable in the developing world. 75 If food is contaminated by blood during pre- chewing it may pose a risk 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 sicknesses using 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that's transported along with the viral genome in the virus particle. The resultant viral DNA is then 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 may become latent, enabling its own host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to disperse between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it uses crossed spreading mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then 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 closest to Lutherville Timonium, Maryland. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's continuing replication against antiretroviral treatments. 85 88

Following the virus enters the body there's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood. 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 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 afterwards with antibody generation, or seroconversion The CD8 T cell response is thought to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been associated with a better prognosis and also slower disease progression, though it does not remove the virus. 92

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Ultimately, 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 illnesses 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 might also be a variable. During the chronic phase, the results 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 decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the majority of CD4 T cell loss occurs during the first weeks of disease, particularly 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 nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas only 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 disease and seeks out. 98 A vigorous immune response initiates the clinically latent phase and controls the infection. CD4 T cells in mucosal tissues remain particularly impacted. 98 Continuous 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 action of several HIV gene products as well as the immune response to HIV replication that is ongoing. It is also linked to the breakdown 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

Lutherville Timonium, MD 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 advised by the United States Preventive Services Task Force for all folks 15years to 65years of age including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers only discover when acute immunodeficiency or AIDS is now apparent they are infected at an advanced phase of the disease. Std Test nearby Lutherville Timonium MD. 27

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Antibody tests in kids younger than 18months are commonly incorrect because of the ongoing existence of maternal antibodies 102 Thus 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 a lot of areas simply wait until either symptoms develop or the child is old enough for antibody testing that is accurate. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Lutherville Timonium Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were analyzed 103 which represented a significant increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disorder for surveillance purposes: 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 often adopted in developed nations. Since the WHO 's staging system does not require lab tests, it is satisfied to the resource-controlled conditions seen in developing countries, where it can be used to help guide clinical management. Despite their differences, the two systems permit 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 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 provide an equivalent level of protection. Std Test in Lutherville Timonium. 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 raise the risk of transmission because of its propensity to cause vaginal and rectal 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 UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female to male HIV transmission in 2007 in areas using a high rates of HIV. 112 Yet, whether it protects against male to female transmission is contested, 113 114 and whether it is of benefit in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, nevertheless, does recommend for all sexually active heterosexual males and that it be discussed with men who have sex with men as an alternative. 118 Some experts worry that a lower perception 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 affect subsequent HIV risk. 120 Evidence of any gain from peer instruction is equally poor. 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 very own risk of becoming infected with HIV. Std test near MD, United States. 123 Voluntary counseling and testing people for HIV will not affect risky behavior in those who test negative but does raise condom use in those who test positive. 124 It is not known whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among people with HIV whose CD4 count 550 cells/L is an extremely productive way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test nearby Lutherville Timonium Maryland, United States. 125 TASP is associated 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 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 successful in intravenous drug users with a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are mixes (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially treatment 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 above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in individuals of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 Once treatment is started it is recommended that it is continued without breaks or "vacations". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desirable results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is powerful are initially recommended after four weeks and once levels fall below 50copies/mL tests every three to six months are typically adequate. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is effective in more than 95% of folks during the first year. 27

Advantages of treatment include a reduced risk of progression to AIDS and also a decreased danger of departure. Std Test nearby Lutherville Timonium, Maryland. Physical and mental health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a reduced risk of transmission to sexual partners of the disease and also a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a large part on conformity. 27 Rationales 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 price is an important issue with some medications, 152 47% of people who needed they were being taken by them in middle and low income nations as of 2010 143 as well as the speed of adherence is comparable in low-income and high income states. 153

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