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The initial symptoms are followed by a stage called long-term HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second period 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 generally there are few or no symptoms in the beginning, near the end of the phase many people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also grow persistent generalized lymphadenopathy , defined 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 nearby Evart, Michigan. Evart MI std test. 2

Although most HIV-1 infected people have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a small proportion (about 5%) keep elevated levels 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 "elite controllers" or "top-notch suppressors". They represent about 1 in 300 contaminated individuals. Evart, 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 incidence of specific disorders in association with an HIV disease. Std Test near Evart Michigan United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common first conditions that alarm to the presence 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 a higher 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 individuals with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of almost 16% of people who have AIDS and is the first indication of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently 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 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 nevertheless, the routine of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this population 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 bisexual and gay guys have HIV. 49 50 Std test in Evart.

With regard to unprotected heterosexual contacts, estimates 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 act, and of male to female transmission as 0.30% per act; the equivalent estimates for high income nations 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 homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it's still present. 53 The risk from getting oral sex was described as "almost nil"; 54 however, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings involving 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 action. 51

The next most common way 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 threat from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std Test nearby MI, 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 act and the danger following mucous membrane exposure to infected 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 a few places more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated blood. 63 In developed nations the danger of acquiring 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 danger 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's estimated that up to 15% of HIV infections in these areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global diseases. Std Test near me MI, United States. 11 68 Although rare because of screening, it will be possible to acquire 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 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 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 could be reduced to about 1%. 73 Prophylactic treatment includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decline the risk of transmission in people who do breastfeed. 76 Many of these measures are however not accessible the developing world. 75 If food is contaminated by blood during pre- chewing it may present a risk of transmission. 71

HIV is a part 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 illnesses using a lengthy 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 is 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, enabling its host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus might be transcribed, generating viral proteins that are packaged and discharged 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 understood to disperse between CD4 T cells by two parallel routes: 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 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 near me Evart Michigan. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's on-going replication against antiretroviral therapies. 85 88

After the virus enters the body there is a period of rapid viral replication, resulting in an abundance 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 response is accompanied by a noticeable 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 afterwards with antibody production, or seroconversion The CD8 T cell reaction is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was linked to slower disease progression and also a better prognosis, though it will not get rid of the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are critical to the immune response and without them, the body cannot fight infections or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic and acute periods. 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 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

Although the symptoms of immune deficiency feature of AIDS don't appear for years after an individual is infected, the bulk of CD4 T cell loss happens during the first weeks of infection, particularly in the intestinal mucosa, which harbors the majority of the lymphocytes found within 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 gain access to 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 destroys CCR5 expressing CD4 T cells during acute infection and seeks out. 98 A vigorous immune response controls the infection and begins the latent period. CD4 T cells in mucosal tissues remain especially changed. 98 Constant HIV replication causes a state of generalized immune activation lasting throughout the long-term stage. 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 and also the immune response to ongoing HIV replication. Additionally it is linked to the breakdown 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

Evart MI 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 advocated by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Also, testing is recommended for those at high risk, which includes anyone. 27 In many regions of the world, a third of HIV carriers only find when AIDS or severe immunodeficiency has become apparent, they're infected at an advanced stage of the disease. Std test nearest Evart MI. 27

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Antibody tests in children younger than 18months are typically incorrect because of the continuing 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 lots of places simply wait until either symptoms develop or the child is old enough for accurate antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Evart Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan countries were tested 103 which signified a considerable 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 and the CDC classification system for HIV infection 104 The CDC 's classification system is more often embraced in developed countries. Since the WHO 's staging system doesn't need lab evaluations, it is satisfied to the resource-restricted conditions seen in developing countries, where it can be used 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 rate of HIV infection is less than 1% per year. 107 There's some evidence to imply that female condoms may offer an equivalent level of protection. Std test nearby Evart. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems 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 due to 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, both 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 Nonetheless, 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 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 vulnerability among circumcised men may cause more sexual risk taking behavior, thereby negating its prophylactic effects. 119

Programs encouraging sexual abstinence don't appear to impact subsequent HIV risk. 120 Signs of any benefit from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A substantial minority of young people proceeds to engage in high risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test nearest MI United States. 123 Voluntary counseling and testing individuals for HIV does not change risky behaviour in those who test negative but does raise 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 effective method to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std test nearest Evart Michigan, 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 successful in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It might also be successful 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 mixes (or "cocktails") consisting of at least three medications belonging to at least two types, or "groups," of antiretroviral agents. 144 Initially treatment is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue 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 advocates antiretrovirals in folks of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is started it is advised that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have begun. 27 The desired results of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to find out if treatment is effective are initially recommended after four weeks and once levels fall below 50copies/mL tests every three to six months are typically adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of folks during the very first year. 27

Advantages of treatment include a decreased risk of progression to AIDS as well as a decreased risk of departure. Std test nearest Evart, Michigan. 147 In the developing world treatment also enhances physical and mental health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a decreased danger of transmission to sexual partners of the disease and also a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 27 Motives for non-adherence include poor access to medical care, 149 inadequate 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 Even though price is an important issue with some medications, 152 47% of people who wanted they were being taken by them in middle and low income countries as of 2010 143 as well as the speed of adherence is comparable in low income and high-income countries. 153

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