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The first symptoms are followed by a period called asymptomatic HIV, clinical latency, or long-term HIV. 1 Without treatment, this second phase 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 typically there are few or no symptoms initially, close to the end of this stage lots of people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals 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 nearby Lake, Michigan. Lake MI std test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a tiny proportion (about 5%) keep elevated amounts 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 maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 persons that are contaminated. Lake, 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 in Lake Michigan United States. 26 In the absence of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alarm to the presence 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

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 individuals with HIV. 35 The second most common cancer is lymphoma, which is the first signal of AIDS in 3 to 4% and is the cause of death of almost 16% of individuals with AIDS. 35 Both these cancers are linked with 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 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 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 however, the routine of transmission varies significantly among countries. As of 2014, most HIV transmission in the USA occurred among men who had sex with guys, with this specific public 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 men have HIV. 49 50 Std test near me Lake.

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 countries. 51 In low-income countries, the danger 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 approximations 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 danger of transmission from oral sex is relatively low, it's still present. 53 The risk from receiving oral sex was described as "nearly nil"; 54 yet, a few cases are 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 has been estimated as 2.4% per act 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 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 action, with an average of 0.8%. Std Test near MI 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 act and the threat following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per action. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in certain areas more than 80% of those who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed countries the risk of acquiring 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 UK 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 appropriately screened (as of 2008), 67 and it's 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 diseases. Std test nearest MI, United States. 11 68 Although rare because of screening, it's possible to get 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 individuals who also 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 involves the mom avoiding 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 decline the risk 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- it may pose a threat 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 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 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 own host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, creating viral proteins that are packaged and released from the cell as new virus particles that start the replication cycle afresh and new RNA genomes. 84

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HIV is now understood to spread between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it employs crossed spreading mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid then infect another T cell following a chance encounter. 85 HIV can also disseminate by direct transmission from one cell to another by a process of cell-to-cell spread. Std test nearest Lake, Michigan. 86 87 The hybrid spreading mechanics of HIV contribute to the continuing replication of the virus against antiretroviral therapies. 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 response is accompanied by a noticeable drop 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 generation, or seroconversion The CD8 T cell response is regarded as 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 was linked to slower disease progression and a better prognosis, though it doesn't eliminate the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This weakens the immune system and permits opportunistic infections T cells are crucial 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 acute and chronic 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 factor. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells appear to account for the slow decline in CD4 T cell numbers. 94

Even though the symptoms of immune deficiency characteristic of AIDS don't appear for decades after a person is infected, the bulk of CD4 T cell loss occurs during the first weeks of infection, especially 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 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 just a tiny 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 illness and seeks out. 98 A vigorous immune response starts the clinically latent phase and eventually controls the infection. CD4 T cells in mucosal tissues stay especially impacted. 98 Continuous 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 pro-inflammatory cytokines, results from the activity of several HIV gene products and also the immune response to ongoing HIV replication. It is also linked to the dysfunction 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

Lake MI 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 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 sections of the planet, a third of HIV carriers just discover they're infected at an advanced phase of the disease when acute immunodeficiency or AIDS has become evident. Std Test near me Lake, MI. 27

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Antibody tests in kids younger than 18months are usually inaccurate due to the continued existence 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 many places simply wait until either symptoms grow or the kid is old enough for accurate antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were informed of their HIV status. Lake Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were tested 103 which signified a substantial increase compared to previous years. 103

Two chief 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 and also the CDC classification system for HIV infection 104 The CDC 's classification system is more often adopted in developed nations. Since the WHO 's staging system does not need laboratory evaluations, it's satisfied to the resource-controlled states encountered in developing countries, where it can also be used to help direct clinical management. Despite their differences, both systems permit comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger 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's some evidence to imply that female condoms may provide an equivalent level of protection. Std test nearest Lake. 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 men by between 38% and 66% over 24 months". 111 Due to these studies, both the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female-to-male HIV transmission in places with a high rates of HIV in 2007. 112 Nevertheless, whether it protects against male-to-female transmission is contested, 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 recommend for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men. 118 Some experts fear that a lower perception of vulnerability among circumcised men may cause more sexual risk taking behaviour, hence negating its preventative effects. 119

Programs supporting sexual abstinence don't appear to change subsequent HIV danger. 120 Signs 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 large minority of young people proceeds to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std Test in MI United States. 123 Voluntary counselling and testing individuals for HIV does not affect risky behaviour in those who test negative but does raise condom use in those who test positive. 124 It isn't known whether treating other sexually transmitted infections is successful in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely effective way to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std test nearby Lake Michigan, United States. 125 TASP is related to 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 successful in several groups including men who have sex with men, couples where one is HIV positive, and young heterosexuals in Africa. 109 It may also be effective in intravenous drug users with a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are mixtures (or "cocktails") consisting of at least three drugs belonging to at least two types, or "classes," of antiretroviral agents. 144 Initially treatment is generally a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents including protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

The World Health Organization and United States advocates antiretrovirals in people of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 Once treatment is started it is recommended that it's continued without breaks or "holidays". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desired result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is effective are initially advocated after four weeks and once amounts fall below 50copies/mL checks every three to six months are usually adequate. 27 Insufficient 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 first year. 27

Benefits of treatment include a reduced risk of death as well as a reduced risk of progression to AIDS. Std test near Lake, Michigan. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a decreased danger of transmission of the illness to sexual partners as well as a decrease in mom-to-child transmission. The effectiveness of treatment depends to a large part on conformity. 27 Rationales 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 Even though cost is an important issue with some medications, 152 47% of people who wanted them were taking them in the rate of adherence as well as middle and low income nations as of 2010 143 is comparable in low-income and high-income countries. 153

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