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The initial symptoms are followed by a stage called asymptomatic HIV clinical latency, or persistent HIV. 1 Without treatment, this second period 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 generally there are few or no symptoms in the beginning, near the end of the period many people experience gastrointestinal problems, weight loss, fever and muscle pains. 1 Between 50 and 70% of individuals 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 Warwick Maryland. Warwick, MD 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 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 people are classified as HIV controllers or long-term nonprogressors (LTNP). 31 Another group consists of individuals who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent approximately 1 in 300 contaminated persons. Warwick 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 diseases in association with an HIV disease. Std test nearby Warwick Maryland, United States. 26 In the absence 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 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 a higher 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, which is the cause of death of nearly 16% of individuals with AIDS and is the initial indication of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often in those with AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids and also the white part of the eye) is also more common in those with HIV. 36

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The most common mode of transmission of HIV is through sexual contact with an infected person. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this 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 homosexual and bisexual men have HIV. 49 50 Std Test closest to Warwick.

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 nations, 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 approximations for high-income states are 0.04% per act 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 danger from getting oral sex has been described as "almost nil"; 54 yet, a few instances have been 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 was estimated as 2.4% per action and male to female transmission as 0.05% per action. 51

The 2nd most frequent 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 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 nearby MD, United States. 63 The risk of acquiring 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 infected blood as 0.09% (about 1 in 1000) per act. 47 In America 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 countries 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 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 areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test in MD, United States. 11 68 Although rare because of screening, it will be likely to get HIV from organ and tissue transplantation 69

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HIV may 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 internationally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in those who also breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the risk of mother-to-child infection can be reduced to about 1%. 73 Preventive treatment includes 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 either the mother or the infant decrease the risk 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 might present a threat 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 using a long 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 together with the viral genome in the virus particle. The consequent 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 incorporated, the virus might become latent, enabling the virus and its host cell to avoid detection by the immune system. 83 Alternatively, the virus could be transcribed, producing new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that start the replication cycle afresh. 84

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HIV is now known to disperse between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it applies crossed spreading mechanics. 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 may also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std test nearby Warwick Maryland. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's ongoing replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, resulting in plenty of virus in the peripheral blood after the virus enters the body. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable fall in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody production, or seroconversion The CD8 T cell reaction is thought to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response has been linked to slower disease progression along with a better prognosis, though it doesn't eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are essential to the immune response and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the long-term and acute 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 factor. During the chronic period, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells seem to account for the slow decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for decades after someone is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body, particularly during the very first weeks of illness. 95 The reason for 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 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 disease and seeks out. 98 A vigorous immune response begins the latent stage and controls the disease. CD4 T cells in mucosal tissues remain particularly affected. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the chronic period. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of several HIV gene products and the immune response to ongoing HIV replication. Additionally it is 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

Warwick MD Std Test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years old 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 regions of the world, a third of HIV carriers simply discover when severe immunodeficiency or AIDS has become evident they're infected at an advanced period of the disease. Std test nearby Warwick, MD. 27

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Antibody evaluations in kids younger than 18months are generally wrong because of the continued existence of maternal antibodies 102 Hence 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 trusted PCR testing and several places simply wait the child 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. Warwick std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were tested 103 which signified a significant increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related ailment for surveillance purposes: the WHO disorder staging system for HIV infection and disease , 24 along with the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently embraced in developed nations. Since the WHO 's staging system does not need laboratory tests, it's suited to the resource-controlled states seen in developing countries, where it can be utilized to help direct clinical management. Despite their differences, the two systems permit 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 by a couple in which one individual 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 level of protection. Std test near Warwick. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears 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 rectal and vaginal 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female to male HIV transmission in 2007 in areas with a high rates of HIV. 112 Nonetheless, whether it shields against male to female transmission is questioned, 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 advocate 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, thereby negating its prophylactic effects. 119

Plans supporting sexual abstinence don't seem to impact subsequent HIV risk. 120 Evidence of any advantage from peer instruction is equally poor. 121 Comprehensive sexual education provided at school may decrease high risk behaviour. 122 A substantial minority of young people continues to engage in high-risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test nearest MD, United States. 123 Voluntary counseling and testing individuals for HIV does not influence dangerous behaviour in individuals who test negative but does raise 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 effective method to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearby Warwick Maryland 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 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 youthful heterosexuals in Africa. 109 It may also be effective in intravenous drug users using a study finding a reduction in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are blends (or "cocktails") consisting of at least three medications belonging to at least two types, or "classes," 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 Blends of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women when the diagnosis 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 individuals are diagnosed only after treatment ideally should have begun. 27 The desirable result 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 degrees fall below 50copies/mL checks every three to six months are usually sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of folks during the very first year. 27

Benefits of treatment contain a reduced risk of progression to AIDS and also a decreased risk of death. Std Test nearest Warwick, Maryland. 147 In the developing world treatment also enhances physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a reduced risk of transmission to sexual partners of the disease and also a drop in mother-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 insufficient 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 Even though cost is an important issue with some medicines, 152 47% of people who needed them were taking them in the rate of adherence as well as low and middle income countries as of 2010 143 is similar in low income and high income countries. 153

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