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The initial symptoms are followed by a stage called asymptomatic HIV, clinical latency, or chronic HIV. 1 Without treatment, this second stage of the natural history of HIV disease can continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms in the beginning, close to the end of this phase a lot of people experience gastrointestinal problems, weight loss, fever and muscle pains. 1 Between 50 and 70% of individuals also grow 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 nearest Wollaston Massachusetts. Wollaston, 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 tiny percentage (about 5%) keep high amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals are classified as HIV controllers or long term nonprogressors (LTNP). 31 Another group consists of those who maintain a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 persons that are infected. Wollaston 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 infection. Std test closest to Wollaston Massachusetts United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring initial conditions that alarm 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 an increased 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 frequent cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the first hint of AIDS in 3 to 4% and is the cause of death of almost 16% of people 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 interior part of eyelids and 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this particular public accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of bisexual and homosexual guys have HIV. 49 50 Std Test nearest Wollaston.

With respect to unprotected heterosexual contacts, estimates of the risk of HIV transmission per sexual act appear 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 action; the equivalent estimates for high income countries are 0.04% per action 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 action in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The danger from getting oral sex was described as "virtually nil"; 54 nevertheless, a couple instances are 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 action and male to female transmission as 0.05% per act. 51

The next most frequent 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 shots with unsterilized equipment. The danger from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std test closest to MA, United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per action. 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 people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations 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 example, in the UK 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 appropriately screened (as of 2008), 67 and it's estimated that up to 15% of HIV infections in these regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std Test nearest MA United States. 11 68 Although rare due to screening, it's likely 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 baby. 73 74 This is the third most common manner 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 those who also 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 may be reduced to about 1%. 73 Preventative treatment includes 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 the mother or the infant decline the risk of transmission in those who do breastfeed. 76 Many of these measures are yet not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it might pose a danger 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 accountable for long-duration illnesses 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 (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 resultant viral DNA is subsequently imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once integrated, the virus may become latent, allowing its host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, producing new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that begin the replication cycle afresh. 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 uses 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 procedure for cell-to-cell spread. Std test closest to Wollaston, Massachusetts. 86 87 The hybrid spreading 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 amount of HIV may reach several million virus particles per milliliter of blood. 91 This response is accompanied by a noticeable fall in the number of circulating CD4 T cells. The acute viremia is almost invariably 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 considered to be important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was linked to a better prognosis as well as slower disease progression, though it does not eliminate the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are essential 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 might also be a variable. During the chronic phase, the consequences 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 characteristic of AIDS don't appear for years after an individual is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found within the body, especially during the first weeks of infection. 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 only a little 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 seeks out and destroys CCR5 expressing CD4 T cells during acute illness. 98 A vigorous immune response controls the infection and starts the clinically latent stage. CD4 T cells in mucosal tissues stay particularly affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term phase. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory 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 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

Wollaston MA std test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the existence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Also, testing is suggested for those at high risk, which includes anyone. 27 In many areas of the world, a third of HIV carriers only find they are infected at an advanced phase of the disorder when AIDS or severe immunodeficiency has become evident. Std test nearest Wollaston MA. 27

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Antibody evaluations in kids younger than 18months are typically inaccurate because of the continued presence of maternal antibodies 102 Hence 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 areas simply wait the child is old enough for antibody testing that is exact 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. Wollaston Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which represented a significant increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-related ailment 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 frequently adopted in developed nations. Since the WHO 's staging system doesn't require lab tests, it's satisfied to the resource-controlled states seen in developing countries, where it can be used to help guide clinical management. Despite their differences, the two systems enable 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 person is infected, the speed of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may provide an equal level of protection. Std test nearby Wollaston. 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 because of its inclination to cause rectal and vaginal 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 recommended male circumcision as a method of preventing female to male HIV transmission in places using a high rates of HIV in 2007. 112 However, whether it shields against male-to-female transmission is challenged, 113 114 and whether it's of benefit in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, does recommend for all sexually active heterosexual males and that it be discussed with men who have sex with men as an alternative. 118 Some experts worry that a lower understanding of vulnerability among circumcised men may cause more sexual risk-taking behavior, thereby negating its preventative effects. 119

Plans supporting sexual abstinence don't seem to influence subsequent HIV risk. 120 Signs of any advantage from peer instruction is equally poor. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A large minority of young people continues to engage in high-risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test nearby MA, United States. 123 Voluntary counselling and testing people for HIV doesn't influence dangerous behaviour in individuals who test negative but does increase condom use in individuals who test positive. 124 It is not 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 quite an productive way to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std test nearest Wollaston Massachusetts, United States. 125 TASP is connected 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 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 may also be successful in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially therapy is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations 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 folks of all ages including pregnant women when the investigation is made regardless of CD4 count. 14 118 146 After treatment is begun it's advised that it is continued without breaks or "vacations". 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 Degrees to determine if treatment is successful are initially recommended after four weeks and once levels drop below 50copies/mL checks every three to six months are generally 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 individuals during the first year. 27

Benefits of treatment include a reduced danger of death and also a decreased risk of progression to AIDS. Std test near me Wollaston, Massachusetts. 147 In the developing world treatment also enhances mental and physical health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased risk of transmission of the disease to sexual partners and also a reduction in mother-to-child transmission. The effectiveness of treatment depends to a big 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 Even though price is an important issue with some medications, 152 47% of those who wanted them were taking them in the speed of adherence and middle and low income countries as of 2010 143 is comparable in low income and high-income states. 153

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