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The initial symptoms are followed by a period called continual HIV, asymptomatic HIV, or clinical latency. 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 usually there are few or no symptoms at first, close to the end of the phase lots of 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 groin) for over three to six months. Std Test near me Bloomfield Montana. Bloomfield MT Std Test. 2

Although most HIV-1 infected people have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a tiny proportion (about 5%) retain 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 individuals who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent around 1 in 300 contaminated persons. Bloomfield Montana 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 Bloomfield Montana United States. 26 In the lack of special treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring first 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 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, that is the cause of death of nearly 16% of people with AIDS and is the initial indication of AIDS in 3 to 4%. 35 Both these cancers are associated 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 as well as the white portion 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 individual. 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 men, with this people 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 guys have HIV. 49 50 Std test closest to Bloomfield.

With respect 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 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 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 risk of transmission from anal intercourse is especially 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 is still present. 53 The danger from getting oral sex has been described as "almost nil"; 54 yet, a few cases have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings including prostitution in low income countries, risk of female-to-male transmission was estimated as 2.4% per act and male-to-female transmission as 0.05% per act. 51

The next most common mode 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 contaminated blood or blood product, or medical shots with unsterilized equipment. The danger 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 MT, United States. 63 The danger of acquiring HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per act. 47 In America intravenous drug users made up 12% of all new cases of HIV in 2009, 64 and in a few 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 threat 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 areas come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std test nearest MT, United States. 11 68 Although rare due to screening, it's possible to get 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 lack of treatment, the danger 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 appropriate treatment the danger of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment includes the mom administering antiretroviral drugs to the newborn, avoiding breastfeeding, and taking antiretrovirals during pregnancy and delivery, an elective caesarean section. 75 Antiretrovirals when taken by either the mother or the baby decline the risk of transmission in those who do breastfeed. Many of these measures are however not accessible the developing world. 75 If blood contaminates food during pre- it may introduce a danger 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 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 (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 consequent viral DNA is subsequently imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once integrated, the virus may become latent, allowing its particular host cell and the virus to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, generating new RNA genomes and viral proteins that are packaged and discharged from the cell as new virus particles that begin the replication cycle afresh. 84

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HIV is now known to distribute between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it uses hybrid propagating mechanisms. 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 process of cell-to-cell spread. Std Test near me Bloomfield, Montana. 86 87 The hybrid dispersing mechanics of HIV lead to the continuing replication of the virus against antiretroviral treatments. 85 88

After the virus enters the body there's 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 response is accompanied by a marked fall in the number of circulating CD4 T cells. The acute viremia is nearly always 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 levels, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to slower disease progression and also a better prognosis, though it doesn't get rid of the virus. 92

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Finally, 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 cells that are cancerous. The mechanism of CD4 T cell depletion differs in the acute and chronic 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 may also be a factor. During the chronic stage, the results 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 decrease in CD4 T cell numbers. 94

Although the symptoms of immune deficiency feature of AIDS don't appear for decades after an individual is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body, especially during the first weeks of infection. 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 gain access to the cells, whereas just 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 begins the latent phase and eventually controls the infection. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation continuing 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 the immune response and several HIV gene products to ongoing HIV replication. It is also 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

Bloomfield MT Std Test. HIV/AIDS is diagnosed via lab testing and then staged based on the existence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all people 15years to 65years of age including all pregnant women. 101 Moreover, testing is recommended 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 simply find when severe immunodeficiency or AIDS is now apparent they're infected at an advanced phase of the disorder. Std Test nearest Bloomfield MT. 27

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Antibody tests in children younger than 18months are normally incorrect due to the continuing existence 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 reliable PCR testing and many places just wait until either symptoms develop or the child is old enough for precise antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were aware of their HIV status. Bloomfield 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 purposes: 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 embraced in developed countries. Since the WHO 's staging system does not need lab tests, it's suited to the resource-restricted states encountered in developing countries, where it can be used to help guide clinical management. Despite their differences, both systems allow comparison for statistical functions. 2 24 104

Consistent condom use reduces the danger of HIV transmission by about 80% over the long term. 106 When condoms are used 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 equal degree of protection. Std Test closest to Bloomfield. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to lessen 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 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 advocated male circumcision as a way of preventing female to male HIV transmission in places with a high rates of HIV in 2007. 112 Nonetheless, whether it shields against male-to-female transmission is questioned, 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, nevertheless, does advocate 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 behavior, thereby negating its prophylactic effects. 119

Programs encouraging sexual abstinence don't seem to affect subsequent HIV risk. 120 Signs of any advantage from peer education is equally inferior. High risk behaviour may be decreased by 121 Comprehensive sexual education provided at school. 122 A considerable minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std test near MT, United States. 123 Voluntary counseling and testing individuals for HIV will not change high-risk behaviour in those who test negative but does increase condom use in those who test positive. 124 It is not understood 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 quite an productive way to prevent HIV disease of their partner (a strategy known as treatment as prevention, or TASP). Std test nearby Bloomfield Montana, 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 drugs tenofovir , with or without emtricitabine , is successful in a number of 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 risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are mixes (or "cocktails") consisting of at least three medications belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially therapy is commonly 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 Blends of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization advocates antiretrovirals in people of all ages including pregnant women as soon as 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 individuals are diagnosed only after treatment ideally should have started. 27 The desired outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is successful are initially recommended after four weeks and once levels 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 standards treatment is effective in more than 95% of people during the first year. 27

Benefits of treatment contain a reduced danger of death and a reduced risk of progression to AIDS. Std test near me Bloomfield, Montana. 147 In the developing world treatment also improves physical and mental health. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Additional advantages include a decreased risk of transmission to sexual partners of the disease as well as a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Motives for non-adherence include poor access to medical care, 149 insufficient 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 cost is an important problem with some drugs, 152 47% of people who needed they were being taken by them in low and middle income nations as of 2010 143 and the speed of adherence is comparable in low-income and high income nations. 153

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