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The first symptoms are followed by a period called asymptomatic HIV clinical latency, or chronic 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 usually there are few or no symptoms initially, near the end of the phase many people experience weight loss, fever, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals 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 in Great Barrington Massachusetts. Great Barrington, MA 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 tiny percentage (about 5%) retain elevated amounts 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 people who keep a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent around 1 in 300 contaminated persons. Great Barrington, 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 occurrence of specific disorders in association with an HIV disease. Std test near Great Barrington Massachusetts United States. 26 In the absence of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alert to the existence of AIDS are pneumocystis pneumonia (40%), cachexia in the type of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have a higher 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 common cancer occurring in 10 to 20% of individuals 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 indication of AIDS in 3 to 4%. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more frequently in those with AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more prevalent in those with HIV. 36

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The most common mode of transmission of HIV is through sexual contact with an infected individual. 11 The bulk 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 states. As of 2014, most HIV transmission in the United States occurred among men who had sex with guys, with this public accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of gay and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test nearest Great Barrington.

With respect to unprotected heterosexual contacts, estimates of the danger of HIV transmission per sexual act appear 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 act, and of male to female transmission as 0.30% per action; the equivalent approximations for high-income nations 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 particularly 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 relatively low, it's still present. 53 The risk from receiving oral sex was described as "almost nil"; 54 nevertheless, 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 has been estimated as 2.4% per act 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 infected 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 action, with an average of 0.8%. Std test near MA, 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 threat following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few places 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 danger of acquiring 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 is 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 infections. Std test in MA, United States. 11 68 Although rare because of screening, it is likely to acquire 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 causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted globally. 11 In the lack of treatment, the risk 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 could be reduced to about 1%. 73 Preventative treatment involves the mother administering antiretroviral drugs to the newborn, averting breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the baby decrease the risk of transmission in those who do breastfeed. 76 Many of these measures are nevertheless not available in the developing world. 75 If blood contaminates food during pre- chewing 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 lengthy 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 (turn transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resultant viral DNA is subsequently 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, allowing the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, generating viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle afresh and new RNA genomes. 84

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HIV is now known to distribute between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it uses crossed propagating mechanisms. 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 procedure of cell-to-cell spread. Std Test near me Great Barrington Massachusetts. 86 87 The hybrid spreading mechanics of HIV lead to the continuing replication of the virus against antiretroviral treatments. 85 88

There is a period of rapid viral replication, leading to plenty of virus in the peripheral blood following 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 amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody generation, or seroconversion The CD8 T cell response is regarded as important in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was linked to a better prognosis along with slower disease progression, though it doesn't get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and allows opportunistic infections T cells are critical 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 long-term phases. 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 variable. During the chronic stage, the results 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS do not appear for decades after someone is infected, the bulk of CD4 T cell loss occurs during the first weeks of illness, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. 95 The reason behind 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 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 infection. The disease is eventually controlled by 98 A vigorous immune response and begins the latent stage. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation lasting throughout the long-term 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 the immune response and several HIV gene products to ongoing HIV replication. Additionally it is linked to the dysfunction 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

Great Barrington, MA 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 advocated 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 regions of the planet, a third of HIV carriers simply discover when acute immunodeficiency or AIDS is now clear they are infected at an advanced period of the disorder. Std test in Great Barrington MA. 27

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Antibody tests in children younger than 18months are usually erroneous due to the continued existence of maternal antibodies 102 So 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 dependable PCR testing and many places simply wait the child is old enough for precise antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Great Barrington std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which signified a considerable increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: 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 often embraced in developed nations. Since the WHO 's staging system doesn't require lab tests, it's suited to the resource-controlled states encountered in developing countries, where it may also be used to help direct clinical management. Despite their differences, both systems enable 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 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 level of protection. Std test in Great Barrington. 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 men by between 38% and 66% over 24 months". 111 Due to these studies the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female to male HIV transmission in 2007 in places with a high rates of HIV. 112 However, whether it protects against male to female transmission is questioned, 113 114 and whether it is of advantage 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 as an option with men who have sex with men and recommend 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 behaviour, thereby negating its preventative effects. 119

Plans encouraging sexual abstinence don't seem to impact subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally poor. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A sizeable minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test near MA United States. 123 Voluntary counseling and testing individuals for HIV doesn't influence high-risk behavior in individuals who test negative but does raise condom use in individuals who test positive. 124 It isn't known 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 a very effective method to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test in Great Barrington Massachusetts, United States. 125 TASP is associated 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 a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It can also be effective in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART alternatives are mixes (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 Combinations of agents including 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 when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it's continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desired outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is successful are initially advocated after four weeks and once amounts drop below 50copies/mL checks every three to six months are typically 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 individuals during the very first year. 27

Advantages of treatment include a decreased danger of departure as well as a reduced risk of progression to AIDS. Std Test nearest Great Barrington Massachusetts. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Added advantages include a reduced danger of transmission of the illness to sexual partners and a drop in mother-to-child transmission. The effectiveness of treatment depends to a big part on compliance. 27 Rationales 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 though cost is an important issue with some medications, 152 47% of those who wanted they were being taken by them in the speed 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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