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The first symptoms are followed by a stage called asymptomatic HIV, clinical latency, or long-term HIV. 1 Without treatment, this second stage of the natural history of HIV infection can continue from around three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms initially, close to the end of this stage lots 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 Sweet Grass, Montana. Sweet Grass, MT std test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the absence of treatment will eventually progress to AIDS, a tiny proportion (about 5%) keep high levels 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 those who keep a low or undetectable viral load without anti retroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 individuals that are infected. Sweet Grass, 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 incidence of specific diseases in association with an HIV disease. Std Test nearby Sweet Grass Montana United States. 26 In the absence of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common 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

People 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 typical cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of nearly 16% of individuals with AIDS and is the initial hint of AIDS in 3 to 4%. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more frequently in people that have AIDS because of 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in the United States occurred among men who had sex with men, with this particular public accounting for 83% of new cases among males over 12 years old and 67% of new cases. 49 About 15% of homosexual and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test nearby Sweet Grass.

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 states. 51 In low income countries, the risk 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 countries are 0.04% per act for female-to-male transmission, and 0.08% per action for male to female transmission. 51 The danger of transmission from anal intercourse is especially 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 danger from getting oral sex was described as "nearly nil"; 54 yet, a couple 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 action and male to female transmission as 0.05% per action. 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 shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std test closest to MT, United States. 63 The risk 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 threat following mucous membrane exposure to contaminated blood as 0.09% (about 1 in 1000) per act. 47 In the United States intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few 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 nations the danger of acquiring 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 example, 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 is 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 near me MT, United States. 11 68 Although rare because of screening, it will be 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 causing infection in the infant. 73 74 This is the third most common way 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 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 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. Many of these measures are yet not available in the developing world. 75 If blood contaminates food during pre- chewing it may introduce a risk of transmission. 71

HIV is an associate 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 in charge of long-duration illnesses using 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 (reverse transcribed) into double-stranded DNA by a virally encoded reverse transcriptase that's transported together with the viral genome in the virus particle. The resultant 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 incorporated, the virus may become latent, enabling its own host cell and the virus 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 afresh and new RNA genomes. 84

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HIV is now known to disperse 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 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 in Sweet Grass Montana. 86 87 The hybrid spreading mechanisms of HIV contribute to the virus's on-going replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, leading to plenty of virus in the peripheral blood after the virus enters the body. During primary infection, the level of HIV may reach several million virus particles per milliliter of blood. 91 This reaction is accompanied by a marked drop in the number of circulating CD4 T cells. The acute viremia is almost invariably associated with activation of CD8 T cells , which kill HIV-infected cells, and afterwards with antibody production, or seroconversion The CD8 T cell response is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A great CD8 T cell response was linked to slower disease progression and a better prognosis, though it doesn't remove the virus. 92

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Finally, HIV causes AIDS by depleting CD4 T cells the immune system weakens and permits opportunistic infections T cells are critical to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. The mechanism of CD4 T cell depletion differs in the acute and long-term 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 variable. During the chronic period, 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 feature of AIDS do not appear for years after an individual is infected, the bulk of CD4 T cell loss happens during the first weeks of illness, especially in the intestinal mucosa, which harbors most of the lymphocytes found within the body. 95 The reason behind 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 only 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 illness and seeks out. 98 A vigorous immune response begins the clinically latent period and eventually controls the disease. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the chronic period. 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 the immune response and several HIV gene products to ongoing HIV replication. Additionally it is linked to the breakdown 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

Sweet Grass MT 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 advised by the United States Preventive Services Task Force for all people 15years to 65years old including all pregnant women. 101 Also, testing is recommended for those at high risk, which comprises anyone. 27 In many sections of the planet, a third of HIV carriers only discover they are infected at an advanced period of the disorder when acute immunodeficiency or AIDS is now obvious. Std Test near Sweet Grass, MT. 27

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Antibody evaluations in children younger than 18months are usually erroneous 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 several areas just wait the child is old enough for antibody testing that is accurate or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. Sweet Grass std test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were examined 103 which represented a significant increase compared to preceding years. 103

Two principal 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 also 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 doesn't require lab tests, it's satisfied to the resource-controlled states encountered in developing countries, where it can be used to help guide clinical management. Despite their differences, both systems permit comparison for statistical purposes. 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 provide an equal level of protection. Std Test in Sweet Grass. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex appears to reduce infection rates by about 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 the World Health Organization and UNAIDS advocated male circumcision as a method of preventing female to male HIV transmission in regions with a high rates of HIV in 2007. 112 However, whether it protects against male-to-female transmission is disputed, 113 114 and whether it's of advantage in developed countries and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, however, 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 perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, thus negating its prophylactic effects. 119

Plans encouraging sexual abstinence do not appear to affect subsequent HIV risk. 120 Signs of any benefit from peer instruction is equally poor. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A substantial minority of young people proceeds to engage in high risk practices despite understanding about HIV/AIDS, underestimating their own danger of becoming infected with HIV. Std Test nearest MT, United States. 123 Voluntary counseling and testing people for HIV does not affect high-risk behavior in individuals who test negative but does raise 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 people with HIV whose CD4 count 550 cells/L is quite an productive method to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test nearby Sweet Grass Montana, 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 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 youthful heterosexuals in Africa. 109 It can also be effective in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are mixes (or "cocktails") consisting of at least three drugs belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is usually 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 urges antiretrovirals in people of all ages including pregnant women when the analysis is made regardless of CD4 count. 14 118 146 After treatment is begun it's advised that it's continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have started. 27 The desirable result of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Amounts to find out if treatment is successful are initially recommended after four weeks and once amounts fall below 50copies/mL checks every three to six months are generally adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these criteria treatment is successful in more than 95% of people during the very first year. 27

Benefits of treatment include a decreased risk of progression to AIDS and a reduced risk of departure. Std test near me Sweet Grass Montana. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Added benefits include a decreased risk of transmission to sexual partners of the illness and a drop in mom-to-child transmission. The effectiveness of treatment depends to a big part on compliance. 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 though cost is an important problem with some drugs, 152 47% of people who desired they were being taken by them in middle and low income countries as of 2010 143 and also the speed of adherence is similar in low-income and high income countries. 153

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