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The initial symptoms are followed by a stage called persistent HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV infection can last from around three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are few or no symptoms at first, close to the end of this stage a lot of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , defined by unexplained, non-painful enlargement of greater than one group of lymph nodes (other than in the groin) for over three to six months. Std test closest to Centerville, Massachusetts. Centerville, MA 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 elevated rates of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These people 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 anti retroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent about 1 in 300 infected persons. Centerville, Massachusetts 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 near Centerville Massachusetts, United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring initial 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 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 common 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 first signal of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 and the white portion 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 majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 yet, the pattern of transmission varies significantly among states. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this public accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of homosexual and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std Test nearest Centerville.

With respect 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 countries. 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 action; the equivalent approximations for high-income countries are 0.04% per act for female to male transmission, and 0.08% per act 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 danger of transmission from oral sex is relatively low, it's still present. 53 The risk from getting oral sex has been described as "almost nil"; 54 however, a few instances 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 act and male-to-female transmission as 0.05% per act. 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 infected blood or blood product, or medical shots with unsterilized equipment. The threat from sharing a needle during drug injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std Test near me MA United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per act and the hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in some regions more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed countries the risk 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 instance, in the UK the hazard 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 contaminated blood and blood products, representing between 5% and 10% of global diseases. Std test nearest MA United States. 11 68 Although rare because of screening, it's likely to get HIV from tissue and organ transplantation 69

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HIV can 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 absence of treatment, the danger of transmission before or during birth is around 20% and in people who additionally breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection may be reduced to about 1%. 73 Preventive treatment involves 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 decline the risk of transmission in people who do breastfeed. Many of these measures are nevertheless not obtainable in the developing world. 75 If food is contaminated by blood during pre- chewing it might pose a threat of transmission. 71

HIV is an associate 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 along with the viral genome in the virus particle. The resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once integrated, the virus might become latent, allowing the virus and its particular host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating new RNA genomes and viral proteins which are packaged and discharged from the cell as new virus particles that start the replication cycle over. 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 applies hybrid 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 procedure for cell-to-cell spread. Std Test nearest Centerville Massachusetts. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's ongoing replication 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 response is accompanied by a marked 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 response is believed to be important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good has been linked to slower disease progression and also a better prognosis, though it does not get rid of the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic 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 variable. During the chronic stage, 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 decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS do not appear for many years after someone is infected, the majority of CD4 T cell loss occurs 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 obtain access to the cells, whereas just 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 illness and seeks out. The disease is eventually controlled by 98 A vigorous immune response and begins the clinically latent phase. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the long-term phase. 99 Immune activation, which is revealed 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. Additionally it is 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

Centerville, MA std test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence of particular signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all folks 15years to 65years of age including all pregnant women. 101 Additionally, testing is recommended for those at high risk, which includes anyone. 27 In many areas of the planet, a third of HIV carriers only find when severe immunodeficiency or AIDS has become obvious, they're infected at an advanced stage of the disorder. Std Test near Centerville, MA. 27

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Antibody evaluations in children younger than 18months are typically inaccurate due to the continued presence of maternal antibodies 102 Consequently 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 many areas simply wait until either symptoms develop or the kid is old enough for antibody testing that is accurate. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Centerville std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were analyzed 103 which signified a significant increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related disease for surveillance purposes: 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 often adopted in developed countries. Since the WHO 's staging system doesn't require lab evaluations, it's suited to the resource-controlled states encountered in developing countries, where it can 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 danger 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 imply that female condoms may offer an equal degree of protection. Std test nearby Centerville. 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 raise the risk of transmission due to its propensity 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in places with a high rates of HIV in 2007. 112 Nonetheless, whether it shields against male to female transmission is questioned, 113 114 and whether it's 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 behaviour, hence negating its preventative effects. 119

Plans supporting sexual abstinence don't seem to change subsequent HIV danger. 120 Signs of any advantage from peer education is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A large 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 closest to MA, United States. 123 Voluntary counseling and testing people for HIV will not influence dangerous behavior in individuals who test negative but does raise condom use in those 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 quite an effective way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test in Centerville Massachusetts, United States. 125 TASP is associated with 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 effective 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 successful in intravenous drug users with a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is generally 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 above regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it is recommended that it is continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially urged after four weeks and once amounts drop below 50copies/mL checks every three to six months are typically adequate. 27 Insufficient 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 very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS as well as a decreased risk of death. Std Test in Centerville Massachusetts. Mental and physical health also improves. 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 drop in mom-to-child transmission. The effectiveness of treatment depends to a sizable part on conformity. 27 Reasons for non-adherence include poor access to medical care, 149 inadequate 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 price is an important issue with some medications, 152 47% of those who needed them were taking them in low and middle income nations as of 2010 143 and the speed of adherence is comparable in low-income and high income countries. 153

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