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The first symptoms are followed by a period called asymptomatic HIV, clinical latency, or long-term HIV. 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 typically there are few or no symptoms initially, close to the end of this phase lots of people experience weight loss, fever, gastrointestinal difficulties 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 crotch) for over three to six months. Std Test near Millbury Massachusetts. Millbury MA Std Test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a little proportion (about 5%) keep elevated 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 those who keep 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 individuals. Millbury 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 diseases in association with an HIV disease. Std Test nearest Millbury 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 common initial conditions that alarm to the existence 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the initial indication of AIDS in 3 to 4% and is the cause of death of almost 16% of individuals with AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in people that have 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 portion 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 person. 11 The majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this particular 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 guys have HIV while 28 percent of transgender women test positive. 49 50 Std Test closest to Millbury.

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 countries. 51 In low income nations, the danger 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 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 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 relatively low, it is still present. 53 The danger from getting oral sex has been described as "nearly nil"; 54 nevertheless, a couple 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 act and male to female transmission as 0.05% per act. 51

The next most common mode 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 shots with unsterilized equipment. The threat from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test near MA United States. 63 The danger of getting 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 contaminated blood as 0.09% (about 1 in 1000) per action. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few areas 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 countries the risk 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 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 diseases. Std test closest to MA, United States. 11 68 Although rare due to screening, it really is possible 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 causing infection in the infant. 73 74 This is the third most common way in which HIV is transmitted worldwide. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in individuals who additionally breastfeed 35%. 73 As of 2008, perpendicular 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 involves the mom avoiding breastfeeding, taking antiretrovirals during pregnancy and delivery, an elective caesarean section, 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 yet not accessible the developing world. 75 If blood contaminates food during pre- it may present 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 characteristics. Many species of mammals are infected by lentiviruses, which are characteristically accountable for 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 (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 resulting 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 may become latent, enabling the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, producing viral proteins that are packaged and discharged from the cell as new virus particles that start the replication cycle anew and new RNA genomes. 84

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HIV is now understood to distribute between CD4 T cells by two parallel routes: 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 can also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std Test nearby Millbury Massachusetts. 86 87 The hybrid distributing mechanisms of HIV lead to the ongoing replication of the virus against antiretroviral therapies. 85 88

There is a period of rapid viral replication, leading to plenty 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 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 subsequently with antibody production, or seroconversion The CD8 T cell response is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it does not eliminate the virus a great CD8 T cell response was linked to slower disease progression and a better prognosis. 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 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 may also be a factor. During the chronic stage, the consequences 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

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for decades after a person is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors most of the lymphocytes found in the body, particularly during the very first weeks of infection. 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 just 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 destroys CCR5 expressing CD4 T cells during acute disease and seeks out. The infection is eventually controlled by 98 A vigorous immune response and starts the latent phase. CD4 T cells in mucosal tissues remain particularly changed. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the long-term period. 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 the immune response and several HIV gene products to continuing 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

Millbury, MA std test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence 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 Moreover, testing is suggested for those at high risk, which comprises anyone. 27 In many sections of the planet, a third of HIV carriers just discover when AIDS or acute immunodeficiency has become evident they're infected at an advanced stage of the disease. Std Test nearest Millbury MA. 27

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Antibody evaluations in children younger than 18months are commonly incorrect due to the ongoing presence of maternal antibodies 102 Thus 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 until either symptoms grow or the child is old enough for antibody testing that is precise. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Millbury std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were analyzed 103 which signified a significant increase compared to previous years. 103

Two chief 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 also 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 doesn't require laboratory evaluations, it's satisfied to the resource-controlled conditions encountered in developing countries, where it can be used to help guide clinical management. Despite their differences, both systems allow comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by about 80% over the long term. 106 When condoms are used 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 suggest that female condoms may provide an equivalent level of protection. Std Test nearby Millbury. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may increase the risk of transmission due to its tendency 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, both UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in areas using a high rates of HIV in 2007. 112 Yet, whether it shields 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, nevertheless, does advocate for all sexually active heterosexual males and that it be discussed as an alternative with men who have sex with men. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, hence negating its preventative effects. 119

Plans encouraging sexual abstinence do not appear to affect subsequent HIV danger. 120 Signs of any benefit from peer instruction is equally inferior. 121 Complete sexual education provided at school may fall high risk behaviour. 122 A substantial 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 in MA, United States. 123 Voluntary counselling and testing individuals for HIV does not change hazardous behaviour in individuals who test negative but does increase 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 individuals with HIV whose CD4 count 550 cells/L is an extremely effective method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test nearest Millbury Massachusetts, United States. 125 TASP is connected 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 effective 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 with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

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

United States and the World Health Organization urges antiretrovirals in folks of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desirable results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is successful are initially urged after four weeks and once levels drop below 50copies/mL tests every three to six months are typically sufficient. 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 contain a reduced risk of progression to AIDS and a reduced risk of death. Std Test nearest Millbury Massachusetts. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Additional benefits include a reduced risk of transmission to sexual partners of the illness as well as a reduction in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on compliance. 27 Motives for non-adherence include poor access to medical care, 149 insufficient 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 though price is an important problem with some medicines, 152 47% of people who wanted they were being taken by them in low and middle income nations as of 2010 143 and also the rate of adherence is comparable in low income and high income states. 153

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