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The first symptoms are followed by a period called clinical latency, asymptomatic HIV, 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 generally there are no or few symptoms at first, close to the end of this phase many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop 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 Clyde Township, Michigan. Clyde Township, MI 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 small percentage (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 controllers or long-term nonprogressors (LTNP). 31 Another group consists of those who maintain a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 persons that are infected. Clyde Township, Michigan 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 diseases in association with an HIV disease. Std test nearby Clyde Township Michigan, United States. 26 In the absence of particular 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 cause of death of almost 16% of people who have AIDS and is the first hint of AIDS in 3 to 4%. 35 Both these cancers are linked with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 and also the white portion of the eye) is also more common 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 majority of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 yet, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in America 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. While 28 percent of transgender women test positive, 49 About 15% of homosexual and bisexual men have HIV. 49 50 Std test nearest Clyde Township.

With respect to unprotected heterosexual contacts, approximations 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 countries. 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 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 especially high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the danger of transmission from oral sex is relatively low, it is still present. 53 The risk from getting oral sex was described as "almost nil"; 54 however, a couple cases have been 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 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 injections with unsterilized equipment. The risk from sharing a needle during drug injection is between 0.63 and 2.4% per action, with an average of 0.8%. Std test in MI 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 hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in some regions more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the risk of getting 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 united kingdom 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 suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std test near me MI, United States. 11 68 Although rare because of screening, it will be 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 leading to infection in the infant. 73 74 This is the third most common way in which HIV is transmitted worldwide. 11 In the absence of treatment, the risk of transmission before or during birth is around 20% and in individuals who also breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment includes the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decrease the danger of transmission in those who do breastfeed. Many of these measures are nevertheless not accessible the developing world. 75 If blood contaminates food during pre- chewing it might introduce a danger of transmission. 71

HIV is a part 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 an extended 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's transported together with the viral genome in the virus particle. The consequent viral DNA is then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once integrated, the virus might become latent, enabling the virus and its host cell to prevent detection by the immune system. 83 Instead, the virus might be transcribed, generating viral proteins which are packaged and discharged from the cell as new virus particles that start the replication cycle over and new RNA genomes. 84

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HIV is now known to disperse between CD4 T cells by two parallel paths: cell-free spread and cell-to-cell spread, i.e. it uses crossed 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 procedure for cell-to-cell spread. Std test closest to Clyde Township Michigan. 86 87 The hybrid spreading mechanics of HIV contribute to the continuing replication of the virus against antiretroviral treatments. 85 88

Following the virus enters the body there is a period of rapid viral replication, leading to plenty of virus in the peripheral blood. During primary infection, the amount 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 always associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell response is considered to be significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it will not get rid of the virus a good CD8 T cell response was associated with slower disease progression along with a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are essential 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 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 variable. During the chronic period, 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 characteristic of AIDS don't appear for a long time after an individual is infected, the bulk of CD4 T cell loss happens during the first weeks of illness, particularly in the intestinal mucosa, which harbors most of the lymphocytes found in the body. 95 The reason for the preferential loss of mucosal CD4 T cells is that the majority of mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas only a small 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 destroys CCR5 expressing CD4 T cells during acute infection and seeks out. 98 A vigorous immune response begins the clinically latent stage and controls the infection. CD4 T cells in mucosal tissues stay especially affected. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the long-term phase. 99 Immune activation, which is represented by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the activity of several HIV gene products as well as the immune response to ongoing HIV replication. Additionally it is linked to the breakdown of the immune surveillance system of the gastrointestinal mucosal barrier brought on by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Clyde Township MI Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Additionally, testing is recommended for those at high risk, which comprises anyone. 27 In many areas of the world, a third of HIV carriers only find they're infected at an advanced phase of the disease when acute immunodeficiency or AIDS is now evident. Std Test in Clyde Township, MI. 27

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Antibody tests in kids younger than 18months are typically inaccurate due to the continued presence of maternal antibodies 102 Hence 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 several places just wait until either symptoms develop or the kid is old enough for antibody testing that is accurate. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Clyde Township Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were analyzed 103 which signified a considerable increase compared to preceding years. 103

Two primary clinical staging systems are used to classify HIV and HIV-associated disorder for surveillance purposes: the WHO disease 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 adopted in developed nations. Since the WHO 's staging system does not require lab tests, it's satisfied to the resource-restricted conditions encountered in developing countries, where it may also be used to help direct clinical management. Despite their differences, both systems allow comparison for statistical purposes. 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 rate of HIV infection is less than 1% per year. 107 There's some evidence to suggest that female condoms may offer an equal degree of protection. Std test near Clyde Township. 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 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in 2007 in places using a high rates of HIV. 112 Nevertheless, whether it protects against male to female transmission is disputed, 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 alternative with men who have sex with men and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, thus negating its preventive effects. 119

Plans encouraging sexual abstinence do not appear to impact 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 considerable minority of young people continues to participate in high risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std Test nearest MI United States. 123 Voluntary counseling and testing individuals for HIV does not change dangerous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It is not known 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 a very productive way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test near me Clyde Township Michigan, 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 powerful 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 may 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 blends (or "cocktails") consisting of at least three drugs belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially therapy is typically 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 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 when the analysis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's recommended that it is continued without breaks or "holidays". 27 Many people are diagnosed only 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 find out if treatment is successful are initially advocated after four weeks and once degrees drop below 50copies/mL tests every three to six months are usually 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 individuals during the very first year. 27

Advantages of treatment contain a reduced risk of progression to AIDS and a decreased danger of departure. Std Test near Clyde Township Michigan. Mental and physical health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Added advantages include a decreased danger of transmission of the illness to sexual partners as well as a drop in mom-to-child transmission. The effectiveness of treatment depends to a large part on compliance. 27 Reasons 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 issue with some drugs, 152 47% of those who desired them were taking them in the rate of adherence and low and middle income nations as of 2010 143 is comparable in low income and high-income nations. 153

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