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The first symptoms are followed by a stage called long-term HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV infection can last 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, close to the end of this phase a lot of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals 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 closest to Oxford, Michigan. Oxford, 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 small percentage (about 5%) retain 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 accountants or long term nonprogressors (LTNP). 31 Another group consists of individuals who maintain a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent about 1 in 300 contaminated persons. Oxford, 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 near Oxford 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 common initial conditions that alarm 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 individuals with HIV. 35 The second most common cancer is lymphoma, that is the initial 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 frequently in those with AIDS because of its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the inner part of eyelids and the white part of the eye) is also more common in those with HIV. 36

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The most frequent 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 individuals of the opposite sex); 11 nevertheless, the routine of transmission varies significantly among states. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this population accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of homosexual and bisexual guys have HIV while 28 percent of transgender women test positive. 49 50 Std Test nearest Oxford.

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 countries. 51 In low income nations, 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 estimates for high income countries are 0.04% per act for female-to-male transmission, and 0.08% per action for male to female transmission. 51 The risk 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 danger of transmission from oral sex is relatively low, it is still present. 53 The danger from receiving oral sex was described as "almost nil"; 54 yet, a few instances have been 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 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 injection is between 0.63 and 2.4% per act, with an average of 0.8%. Std test nearest MI, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per act and the risk 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 certain 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 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 UK 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 appropriately screened (as of 2008), 67 and it is 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 infections. Std Test closest to MI, United States. 11 68 Although rare due to screening, it really is likely 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 resulting in 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 people 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 may be reduced to about 1%. 73 Preventative treatment includes the mother 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 baby decrease the risk of transmission in those who do breastfeed. 76 Many of these measures are yet not obtainable in the developing world. 75 If blood contaminates food during pre- chewing it may pose 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 very long 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that's transported along 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 may become latent, allowing the virus and its particular host cell to avoid detection by the immune system. 83 Instead, the virus could be transcribed, producing viral proteins which are packaged and discharged from the cell as new virus particles that begin the replication cycle anew 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 hybrid propagating 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 can also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std Test closest to Oxford Michigan. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's continuing replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, leading to an abundance of virus in the peripheral blood following the virus enters the body. During primary infection, the degree of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked drop in the amount of circulating CD4 T cells. The acute viremia is nearly always associated with activation of CD8 T cells , which kill HIV-infected cells, and subsequently with antibody production, or seroconversion The CD8 T cell response is believed to be significant in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. Though it does not eliminate the virus a great CD8 T cell response has been linked to slower disease progression and also a better prognosis. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are crucial to the immune response and weakens the immune system 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 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 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

Even though the symptoms of immune deficiency characteristic of AIDS do not appear for years after a person is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found in the body, particularly during the first weeks of illness. 95 The reason behind 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 obtain access to the cells, whereas just 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 seeks out and destroys CCR5 expressing CD4 T cells during acute illness. 98 A vigorous immune response controls the infection and begins the clinically latent stage. CD4 T cells in mucosal tissues stay particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation continuing 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 as well as the immune response to HIV replication that is continuing. 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

Oxford MI Std Test. HIV/AIDS is diagnosed via lab testing and then staged based on the presence 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 Moreover, testing is suggested for those at high risk, which includes anyone diagnosed with a sexually transmitted illness. 27 In many areas of the world, a third of HIV carriers only discover they are infected at an advanced stage of the disorder when acute immunodeficiency or AIDS is now apparent. Std Test near me Oxford, MI. 27

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Antibody evaluations in kids younger than 18months are commonly incorrect due to the continuing 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 a lot of places just wait until either symptoms grow or the child is old enough for antibody testing that is exact. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the public were informed of their HIV status. Oxford Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were tested 103 which signified a substantial increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-related ailment for surveillance goals: the WHO disorder staging system for HIV infection and disease , 24 as well as the CDC classification system for HIV infection 104 The CDC 's classification system is more frequently adopted in developed countries. Since the WHO 's staging system does not require laboratory tests, it is suited to the resource-controlled conditions seen in developing countries, where it may also be utilized 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 person 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 equivalent degree of protection. Std test in Oxford. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to reduce infection rates by about 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 the World Health Organization and UNAIDS recommended male circumcision as a way of preventing female-to-male HIV transmission in areas using a high rates of HIV in 2007. 112 Nonetheless, whether it protects against male to female transmission is challenged, 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, nevertheless, does advocate for all sexually active heterosexual males and that it be discussed with men who have sex with men as an alternative. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behaviour, thereby negating its prophylactic effects. 119

Plans supporting sexual abstinence don't seem to impact subsequent HIV danger. 120 Signs of any advantage from peer instruction is equally poor. High risk behavior may be decreased by 121 Comprehensive sexual education provided at school. 122 A significant minority of young people proceeds to engage in high risk practices despite knowing about HIV/AIDS, underestimating their very own danger of becoming infected with HIV. Std test in MI, United States. 123 Voluntary counseling and testing people for HIV will not influence hazardous behavior in individuals who test negative but does increase condom use in those who test positive. 124 It isn't known 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 quite an effective way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std Test in Oxford 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 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 blends (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially treatment is typically 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 mentioned regimen loses effectiveness. 144

United States and the World Health Organization urges antiretrovirals in folks of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it's recommended that it is continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is powerful are initially advocated after four weeks and once levels fall 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 effective in more than 95% of individuals during the first year. 27

Benefits of treatment contain a decreased danger of death as well as a decreased risk of progression to AIDS. Std Test near Oxford 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 Additional advantages include a decreased risk of transmission to sexual partners of the disease and a drop in mother-to-child transmission. The effectiveness of treatment depends to a big part on conformity. 27 Reasons for non-adherence include poor access to medical care, 149 inadequate 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 problem with some medicines, 152 47% of people who needed they were being taken by them in the speed of adherence and also middle and low income countries as of 2010 143 is similar in low-income and high income countries. 153

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