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The first symptoms are followed by a period called persistent HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second period of the natural history of HIV infection can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are no or few symptoms initially, close to the end of this stage many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , characterized 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 Taunton, Massachusetts. Taunton 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 percentage (about 5%) keep elevated levels 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 maintain a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 infected individuals. Taunton, 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 in Taunton Massachusetts, United States. 26 In the lack of particular 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 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 frequent cancer occurring in 10 to 20% of individuals with HIV. 35 The second most common cancer is lymphoma, which is the initial signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of individuals with AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in those with 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 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 globally occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular people accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive 49 About 15% of homosexual and bisexual guys have HIV. 49 50 Std Test near Taunton.

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 nations. 51 In low income countries, the threat 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 estimates for high income states are 0.04% per action for female to male transmission, and 0.08% per act 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 danger of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex has been described as "nearly nil"; 54 nevertheless, 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 act. 51

The second most common 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 infected blood or blood product, or medical injections with unsterilized equipment. The risk from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std test in MA, 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 act and the danger following mucous membrane exposure to contaminated 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 a few 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 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 risk 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 regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std Test nearby MA United States. 11 68 Although rare because of screening, it's 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 causing infection in the baby. 73 74 This is the third most common manner in which HIV is transmitted internationally. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in those 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 danger of mother-to-child infection may be reduced to about 1%. 73 Preventive treatment involves the mom preventing 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 baby decline the danger of transmission in those who do breastfeed. 76 Many of these measures are however not obtainable in the developing world. 75 If blood contaminates food during pre- it may present a danger 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 responsible for long-duration sicknesses with 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 (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 resulting viral DNA is subsequently imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus may become latent, enabling its particular host cell and the virus to prevent 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 begin the replication cycle over. 84

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HIV is now understood to disperse between CD4 T cells by two parallel routes: cell free spread and cell-to-cell spread, i.e. it applies hybrid spreading mechanics. 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 closest to Taunton Massachusetts. 86 87 The hybrid distributing mechanics of HIV lead to the virus's on-going replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, leading to an abundance 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 marked drop in the amount of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell reaction is regarded as important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to a better prognosis and slower disease progression, though it will not remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are critical to the immune response and without them, the body cannot fight illnesses 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 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

Even though the symptoms of immune deficiency feature of AIDS don't appear for a long time after an individual is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors most 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 gain access to the cells, whereas just a tiny 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 illness and seeks out. 98 A vigorous immune response controls the infection and starts the clinically latent period. CD4 T cells in mucosal tissues stay especially impacted. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term phase. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of several HIV gene products and also the immune response 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

Taunton MA std test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Also, testing is suggested for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many sections of the world, a third of HIV carriers only discover when severe immunodeficiency or AIDS has become clear they are infected at an advanced period of the disorder. Std Test near Taunton, MA. 27

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Antibody tests in children younger than 18months are commonly wrong because of the ongoing presence of maternal antibodies 102 So 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 several places just wait the child is old enough for antibody testing that is accurate or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Taunton std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were analyzed 103 which signified a significant increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-related disorder 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 adopted in developed countries. Since the WHO 's staging system doesn't need lab tests, it's satisfied to the resource-restricted conditions seen 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 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 is some evidence to imply that female condoms may offer an equal degree of protection. Std test closest to Taunton. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by approximately 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 guys by between 38% and 66% over 24 months". 111 Due to these studies UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female to male HIV transmission in places with a high rates of HIV in 2007. 112 However, whether it protects against male-to-female transmission is disputed, 113 114 and whether it's 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 alternative with men who have sex with men and advocate for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk taking behavior, thus negating its prophylactic effects. 119

Programs encouraging sexual abstinence do not appear to influence subsequent HIV risk. 120 Signs of any gain from peer instruction is equally poor. 121 Complete sexual education provided at school may fall high risk behavior. 122 A sizeable minority of young people proceeds to participate in high risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test nearby MA, United States. 123 Voluntary counselling and testing people for HIV will not change risky behaviour 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 an extremely effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std test nearest Taunton Massachusetts, United States. 125 TASP is related to 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 successful 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 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 combinations (or "cocktails") consisting of at least three drugs 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 analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs include: 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 recommends antiretrovirals in individuals of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it is advised that it is continued without breaks or "holidays". 27 Many individuals are diagnosed just after treatment ideally should have begun. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is effective are initially urged after four weeks and once degrees drop below 50copies/mL checks every three to six months are typically sufficient. 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

Benefits of treatment contain a reduced danger of death and a reduced risk of progression to AIDS. Std test in Taunton, Massachusetts. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages 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 large 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 cost is an important problem with some drugs, 152 47% of people who needed they were being taken by them in low and middle income nations as of 2010 143 and also the speed of adherence is comparable in low income and high-income countries. 153

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