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The first symptoms are followed by a stage called persistent HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second stage 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 typically there are no or few symptoms at first, close to the end of this phase lots of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also develop 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 Plympton, Massachusetts. Plympton 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 proportion (about 5%) keep elevated rates 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 individuals who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent about 1 in 300 persons that are contaminated. Plympton 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 me Plympton Massachusetts, United States. 26 In the absence of special treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common 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

People 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, which is the cause of death of nearly 16% of people with AIDS and is the first indication of AIDS in 3 to 4%. 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 interior part of eyelids and also 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 individual. 11 The bulk of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 however, 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 men, with this population accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of gay and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std Test near Plympton.

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 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 nations 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 action in both heterosexual and gay 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 "virtually nil"; 54 yet, a few cases are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings involving 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 2nd 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 shots with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std test in MA, United States. 63 The danger of acquiring 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 contaminated 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 64, 2009 and in certain regions more than 80% of people 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 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 example, in the united kingdom the threat 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 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 closest to MA United States. 11 68 Although rare due to screening, it's possible to acquire HIV from tissue and organ transplantation 69

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HIV could 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 people who also breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment involves the mom averting 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 danger of transmission in those 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 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 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 (turn 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 subsequently 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, allowing the virus and its particular 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 courses: cell free spread and cell-to-cell spread, i.e. it applies hybrid propagating mechanisms. 85 In the cell-free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid after which 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 near me Plympton Massachusetts. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's on-going 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 reaction is accompanied by a marked fall 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 reaction is believed to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good has been associated with slower disease progression and also a better prognosis, though it does not get rid of the virus. 92

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Finally, 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 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 might also be a factor. During the chronic phase, the results 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 decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency feature of AIDS don't appear for many years after an individual is infected, the bulk 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 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 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. 98 A vigorous immune response controls the disease and starts the clinically latent phase. CD4 T cells in mucosal tissues remain especially affected. 98 Continuous HIV replication causes a state of generalized immune activation continuing throughout the chronic phase. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products and the immune response to HIV replication that is ongoing. It's also 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

Plympton MA Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advocated by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Additionally, testing is suggested for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers just find when AIDS or acute immunodeficiency has become evident they are infected at an advanced phase of the disorder. Std Test closest to Plympton, MA. 27

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Antibody evaluations in kids younger than 18months are normally erroneous because of the continuing presence 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 reliable PCR testing and lots of places just wait until either symptoms grow or the child is old enough for exact antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Plympton std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which represented a considerable increase compared to previous years. 103

Two primary clinical staging systems are used to classify HIV and HIV-associated disease for surveillance purposes: the WHO disease 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 adopted in developed countries. Since the WHO 's staging system doesn't require laboratory evaluations, it's satisfied to the resource-controlled states seen in developing countries, where it may 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 risk of HIV transmission by approximately 80% over the long term. 106 When condoms are used by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equal level of protection. Std Test in Plympton. 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 the World Health Organization and UNAIDS advocated male circumcision as a way of preventing female to male HIV transmission in regions with a high rates of HIV in 2007. 112 Yet, whether it protects against male-to-female transmission is contested, 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, nevertheless, 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 worry that a lower perception of exposure among circumcised men may cause more sexual risk taking behavior, thereby negating its prophylactic effects. 119

Programs encouraging sexual abstinence do not appear to affect subsequent HIV risk. 120 Evidence of any gain from peer education is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A substantial minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test near MA United States. 123 Voluntary counselling and testing people for HIV does not change high-risk behaviour in those who test negative but does increase condom use in those who test positive. 124 It is not understood 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 quite an effective method to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test nearest Plympton Massachusetts United States. 125 TASP is associated with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications tenofovir , with or without emtricitabine , is powerful in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It can also be successful in intravenous drug users with a study finding a drop 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 treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: 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 mentioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in folks of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After 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 started. 27 The desired results of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is effective are initially recommended after four weeks and once amounts fall below 50copies/mL checks every three to six months are generally adequate. 27 Inadequate 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 very first year. 27

Benefits of treatment include a decreased risk of death and a reduced risk of progression to AIDS. Std test near me Plympton, Massachusetts. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a reduced risk of transmission to sexual partners of the illness and also a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Motives 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 though price is an important issue with some drugs, 152 47% of those who needed they were being taken by them in the speed of adherence and low and middle income nations as of 2010 143 is comparable in low income and high-income states. 153

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