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The initial symptoms are followed by a period called clinical latency, asymptomatic HIV, or persistent HIV. 1 Without treatment, this second period of the natural history of HIV disease can continue from about three years 28 to over 20years 29 (on average, about eight years). 30 While generally there are few or no symptoms initially, close to the end of this period many people experience gastrointestinal difficulties, weight loss, fever 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 Milan, Michigan. Milan 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%) retain high levels of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These people are classified as HIV accountants or long-term nonprogressors (LTNP). 31 Another group consists of individuals who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent about 1 in 300 infected persons. Milan 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 diseases in association with an HIV disease. Std test near Milan Michigan, United States. 26 In the lack of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring 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 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, which is the initial signal of AIDS in 3 to 4% and is the cause of death of nearly 16% of people 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 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 frequent 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 people of the opposite sex); 11 yet, the routine of transmission varies significantly among states. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular 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 gay and bisexual men have HIV. 49 50 Std Test closest to Milan.

With regard to unprotected heterosexual contacts, approximations of the risk of HIV transmission per sexual act seem to be four to ten times higher in low income countries than in high-income states. 51 In low-income nations, the danger 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 approximations for high income nations are 0.04% per act 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 gay contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it is still present. 53 The risk from getting oral sex was described as "virtually 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 act and male to female transmission as 0.05% per action. 51

The second 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 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 near me MI United States. 63 The danger of getting 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 the USA intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in a few areas more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using contaminated 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 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 regions come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std Test in MI United States. 11 68 Although rare due to screening, it will be likely to acquire HIV from tissue and organ 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 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 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 risk of mother-to-child infection may be reduced to about 1%. 73 Preventative treatment involves the mother administering antiretroviral drugs to the newborn, preventing breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by the mother or the infant decrease the danger of transmission in people who do breastfeed. 76 Many of these measures are yet not obtainable in the developing world. 75 If food is contaminated by blood during pre- it may present a threat 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 illnesses 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 is transported along with the viral genome in the virus particle. The resultant viral DNA is then imported into the cell nucleus and incorporated into the cellular DNA by a virally encoded integrase and host co factors. 82 Once incorporated, the virus may become latent, allowing the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus might be transcribed, creating 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 distribute between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it applies crossed propagating 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 procedure for cell-to-cell spread. Std test nearby Milan Michigan. 86 87 The hybrid dispersing mechanics of HIV contribute to the continuing replication of the virus against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in 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 fall in the number of circulating CD4 T cells. The acute viremia is nearly invariably associated with 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 significant in controlling virus levels, which peak and then decline, as the CD4 T cell counts recover. Though it doesn't remove the virus a good CD8 T cell response was associated with slower disease progression and also a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This permits opportunistic infections T cells are critical to the immune response and weakens the immune system and without them, the body cannot fight illnesses or kill cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 might also be a factor. During the chronic stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to generate new T cells seem to account for the slow decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS do not appear for many years after someone is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body, especially 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 little 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 infection and seeks out. The infection is eventually controlled by 98 A vigorous immune response and begins the clinically latent stage. CD4 T cells in mucosal tissues remain especially impacted. 98 Continuous HIV replication causes a state of generalized immune activation prevailing throughout the chronic stage. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the activity of several HIV gene products and the immune response to HIV replication that is ongoing. It's 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

Milan 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 recommended by the United States Preventive Services Task Force for all people 15years to 65years old 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 regions of the planet, a third of HIV carriers only discover when AIDS or severe immunodeficiency has become apparent, they are infected at an advanced stage of the disorder. Std test nearest Milan MI. 27

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Antibody evaluations in children younger than 18months are generally erroneous because of the continuing presence of maternal antibodies 102 Thus 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 trusted PCR testing and many places just wait the child is old enough for accurate antibody testing 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. Milan std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan nations were tested 103 which represented a substantial increase compared to previous years. 103

Two principal clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 and the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently embraced in developed countries. Since the WHO 's staging system doesn't require lab evaluations, it is satisfied to the resource-restricted states seen in developing countries, where it can also be utilized to help guide clinical management. Despite their differences, both systems permit comparison for statistical functions. 2 24 104

Consistent condom use reduces the risk 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 equivalent level of protection. Std Test in Milan. 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 raise 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 guys 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 places with a high rates of HIV in 2007. 112 However, whether it shields against male-to-female transmission is questioned, 113 114 and whether it's of advantage 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 as an option with men who have sex with men. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, hence negating its preventative effects. 119

Plans encouraging sexual abstinence don't seem to change subsequent HIV danger. 120 Evidence of any benefit from peer instruction is equally inferior. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A substantial minority of young people continues to participate in high risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test near me MI United States. 123 Voluntary counselling and testing individuals for HIV doesn't affect risky behavior in those who test negative but does increase condom use in individuals who test positive. 124 It is not understood whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is an extremely effective way to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std test closest to Milan Michigan, United States. 125 TASP is associated 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 powerful 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 choices are blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially therapy is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue 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

United States and the World Health Organization recommends antiretrovirals in folks of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it is recommended that it is continued without breaks or "vacations". 27 Many people 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 Levels to determine if treatment is powerful are initially recommended after four weeks and once levels drop below 50copies/mL tests every three to six months are generally sufficient. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of folks during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS and also a reduced risk of departure. Std Test nearby Milan Michigan. Mental and physical health also improves. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added benefits include a reduced danger of transmission of the disease to sexual partners as well as a drop in mom-to-child transmission. The effectiveness of treatment depends to a sizable part on compliance. 27 Rationales 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 cost is an important problem with some drugs, 152 47% of people who needed them were taking them in the rate of adherence and middle and low income nations as of 2010 143 is similar in low-income and high income countries. 153

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