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The first symptoms are followed by a stage called asymptomatic HIV, clinical latency, or chronic HIV. 1 Without treatment, this second stage of the natural history of HIV disease can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are no or few symptoms in the beginning, near the end of the phase many people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of people also develop persistent generalized lymphadenopathy , characterized 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 in Monarch, Montana. Monarch MT 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 tiny percentage (about 5%) keep elevated amounts of CD4 T cells ( T helper cells ) without antiretroviral therapy for more than 5 years. 26 31 These individuals 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 antiretroviral treatment, known as "top-notch controllers" or "elite suppressors". They represent around 1 in 300 infected individuals. Monarch 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 disorders in association with an HIV disease. Std Test nearest Monarch Montana, 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 initial 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

People with AIDS have a higher 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 common 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 signal 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 the white part 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 individual. 11 The majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 nevertheless, 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 particular 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 Monarch.

With regard to unprotected heterosexual contacts, approximations 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 nations, the danger 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 countries 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 especially high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the danger of transmission from oral sex is comparatively low, it's still present. 53 The risk from receiving oral sex was described as "virtually nil"; 54 yet, a few instances 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 2nd 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 contaminated blood or blood product, or medical injections 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 in MT, United States. 63 The risk of acquiring HIV from a needle stick from an HIV-infected man is estimated as 0.3% (about 1 in 333) per action and the danger following mucous membrane exposure to contaminated 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 certain regions 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 countries the risk of getting 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 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 suitably screened (as of 2008), 67 and it's estimated that up to 15% of HIV infections in these places come from transfusion of infected blood and blood products, representing between 5% and 10% of global infections. Std Test nearest MT, United States. 11 68 Although rare due to screening, it will be likely to get HIV from tissue and organ transplantation 69

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HIV can 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 globally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in people 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 risk of mother-to-child infection can be reduced to about 1%. 73 Prophylactic treatment includes 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. Many of these measures are yet not accessible the developing world. 75 If blood contaminates food during pre- chewing it might 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 illnesses 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that is transported along with the viral genome in the virus particle. The resulting 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 might become latent, allowing its own host cell and the virus to prevent detection by the immune system. 83 Instead, the virus could be transcribed, creating viral proteins that 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 spread between CD4 T cells by two parallel courses: 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 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 procedure for cell-to-cell spread. Std Test closest to Monarch, Montana. 86 87 The hybrid dispersing mechanisms of HIV lead to the virus's ongoing replication against antiretroviral treatments. 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 reaction is accompanied by a noticeable drop in the number of circulating CD4 T cells. The acute viremia is almost always associated with activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell response is considered to be important in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. Though it does not remove the virus a good CD8 T cell response has been linked to slower disease progression as well as a better prognosis. 92

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Finally, HIV causes AIDS by depleting CD4 T cells This allows opportunistic infections T cells are essential to the immune response and weakens the immune system and without them, the body cannot fight diseases or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the long-term 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 may also be a factor. During the chronic period, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for a long time after a person is infected, the majority of CD4 T cell loss happens during the first weeks of infection, especially in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body. 95 The reason behind the preferential loss of mucosal CD4 T cells is that most mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas only 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 destroys CCR5 expressing CD4 T cells during acute infection and seeks out. The infection is eventually controlled by 98 A vigorous immune response and initiates the latent phase. CD4 T cells in mucosal tissues remain particularly impacted. 98 Constant HIV replication causes a state of generalized immune activation persisting throughout the long-term period. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of proinflammatory cytokines, results from the action of the immune response and several HIV gene products to HIV replication that is ongoing. 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

Monarch MT Std Test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the presence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Furthermore, testing is suggested for those at high risk, which includes anyone. 27 In many areas of the world, a third of HIV carriers simply discover when severe immunodeficiency or AIDS is now evident they're infected at an advanced period of the disorder. Std Test nearby Monarch MT. 27

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Antibody evaluations in children younger than 18months are usually wrong because of the continued existence of maternal antibodies 102 So 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 a lot of areas just wait the child is old enough for exact antibody testing or until either symptoms grow. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were informed of their HIV status. Monarch std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan nations were tested 103 which represented a significant increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance goals: 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 frequently adopted in developed nations. Since the WHO 's staging system does not require laboratory evaluations, it is suited to the resource-controlled states seen in developing countries, where it can also be used to help guide clinical management. Despite their differences, the two systems enable comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by about 80% over the long term. 106 When condoms are used consistently by a couple in which one individual is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to imply that female condoms may offer an equivalent degree of protection. Std Test nearest Monarch. 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 tendency to cause rectal and vaginal 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 UNAIDS and the World Health Organization advocated male circumcision as a method of preventing female-to-male HIV transmission in regions using a high rates of HIV in 2007. 112 Yet, 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, nevertheless, does advocate for all sexually active heterosexual males and that it be discussed with men who have sex with men as an option. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk taking behaviour, thereby negating its prophylactic effects. 119

Programs supporting sexual abstinence don't seem to change subsequent HIV risk. 120 Signs of any gain from peer education is equally inferior. 121 Comprehensive sexual education provided at school may fall high risk behaviour. 122 A substantial minority of young people proceeds to participate in high-risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test near me MT, United States. 123 Voluntary counselling and testing people for HIV doesn't influence hazardous behaviour in those who test negative but does increase condom use in individuals who test positive. 124 It isn't understood 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 a very effective method to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std Test near me Monarch Montana, 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 drugs 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 effective in intravenous drug users with a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices 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 analog 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

The World Health Organization and United States urges antiretrovirals in folks of all ages including pregnant women as soon as the analysis is made regardless of CD4 count. 14 118 146 After treatment is started it's recommended that it is continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have started. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is powerful are initially urged after four weeks and once degrees drop below 50copies/mL checks every three to six months are typically sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of individuals during the very first year. 27

Advantages of treatment include a reduced risk of departure and also a reduced risk of progression to AIDS. Std Test closest to Monarch, Montana. 147 In the developing world treatment also improves 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 illness as well as a reduction in mom-to-child transmission. 144 The effectiveness of treatment depends to a sizable part on conformity. 27 Reasons 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 price is an important issue with some medications, 152 47% of those who needed them were taking them in the speed of adherence and also middle and low income nations as of 2010 143 is similar in low income and high income states. 153

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