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The first symptoms are followed by a stage called clinical latency, asymptomatic HIV, or continual 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 typically there are few or no symptoms at first, near the end of the phase lots of people experience fever, weight loss, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals 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 Shantytown, Nevada. Shantytown NV 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 little percentage (about 5%) keep elevated rates 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 maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent about 1 in 300 infected persons. Shantytown, Nevada 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 disorders in association with an HIV infection. Std test nearby Shantytown Nevada, United States. 26 In the lack of specific treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most often occurring initial 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 first hint of AIDS in 3 to 4% and is the cause of death of almost 16% of people who have AIDS. 35 Both these cancers are related to human herpesvirus 8 35 Cervical cancer occurs more often in those with 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 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 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 guys, with this particular population accounting for 83% of new cases among males over 12 years old and 67% of new cases. While 28 percent of transgender women test positive 49 About 15% of homosexual and bisexual men have HIV. 49 50 Std Test in Shantytown.

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 countries, the threat 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 countries are 0.04% per action 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 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 danger from getting oral sex has been described as "nearly nil"; 54 however, a couple instances are 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 has been estimated as 2.4% per action and male to female transmission as 0.05% per act. 51

The second most frequent 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 infected blood or blood product, or medical shots 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 nearby NV United States. 63 The risk of getting HIV from a needle stick from an HIV-infected person is estimated as 0.3% (about 1 in 333) per action and the hazard 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 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 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 instance, in the united kingdom 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 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 closest to NV, United States. 11 68 Although rare because of screening, it's possible to acquire HIV from organ and tissue transplantation 69

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HIV could be transmitted from mother to child during pregnancy, during delivery, or through breast milk leading to infection in the infant. 73 74 This is the third most common manner in which HIV is transmitted worldwide. 11 In the absence of treatment, the danger of transmission before or during birth is around 20% and in those who also breastfeed 35%. 73 As of 2008, perpendicular transmission accounted for about 90% of cases of HIV in children. 73 With appropriate treatment the risk of mother-to-child infection may be reduced to about 1%. 73 Preventative treatment includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decrease the danger of transmission in those who do breastfeed. Many of these measures are yet not obtainable in the developing world. 75 If food is contaminated by blood during pre- chewing it may introduce a danger 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 accountable for long-duration illnesses using 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's transported along with the viral genome in the virus particle. The consequent viral DNA is subsequently 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 might become latent, enabling the virus and its particular host cell to prevent detection by the immune system. 83 Alternatively, the virus may be transcribed, generating viral proteins that are packaged and released from the cell as new virus particles that start 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 courses: cell-free spread and cell-to-cell spread, i.e. it applies hybrid propagating mechanisms. 85 In the cell free spread, virus particles bud from an infected T cell, enter the blood/extracellular fluid and then infect another T cell following a chance encounter. 85 HIV may also disseminate by direct transmission from one cell to another by a procedure of cell-to-cell spread. Std test near Shantytown, Nevada. 86 87 The hybrid distributing mechanisms of HIV contribute to the on-going replication of the virus against antiretroviral treatments. 85 88

There is 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 marked drop 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 later 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. Though it will not get rid of the virus a great CD8 T cell response has been associated with slower disease progression and also 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 cells that are cancerous. The mechanism of CD4 T cell depletion differs in the chronic and acute 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 may also be a factor. During the chronic phase, the consequences 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 decline in CD4 T cell numbers. 94

Although the symptoms of immune deficiency characteristic of AIDS don't appear for a long time 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 most mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to access the cells, whereas merely 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 disease and seeks out. 98 A vigorous immune response begins the latent phase and eventually controls the infection. CD4 T cells in mucosal tissues remain especially affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the chronic phase. 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 as well as several HIV gene products to HIV replication that is ongoing. 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

Shantytown, NV std test. HIV/AIDS is diagnosed via lab testing and then staged on the basis of the existence of certain signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Also, testing is suggested for those at high risk, which comprises anyone. 27 In many sections of the world, a third of HIV carriers just find when acute immunodeficiency or AIDS has become clear, they're infected at an advanced period of the disorder. Std Test in Shantytown, NV. 27

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Antibody evaluations in kids younger than 18months are typically erroneous due to the ongoing presence of maternal antibodies 102 So HIV disease 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 grow or the kid is old enough for exact antibody testing. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the people were aware of their HIV status. Shantytown std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a significant increase compared to preceding years. 103

Two primary 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 often embraced in developed countries. Since the WHO 's staging system does not require laboratory evaluations, it's suited to the resource-controlled states seen in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, the two 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 individual 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 Shantytown. 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 because of its inclination 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, both UNAIDS and the World Health Organization recommended male circumcision as a method of preventing female-to-male HIV transmission in regions with a high rates of HIV in 2007. 112 Nevertheless, whether it shields against male-to-female transmission is questioned, 113 114 and whether it's of benefit in developed nations 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 understanding of vulnerability among circumcised men may cause more sexual risk-taking behaviour, hence negating its preventive effects. 119

Programs supporting sexual abstinence do not appear to affect subsequent HIV danger. 120 Evidence of any gain from peer instruction is equally inferior. 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 understanding about HIV/AIDS, underestimating their very own risk of becoming infected with HIV. Std test in NV United States. 123 Voluntary counselling and testing people for HIV doesn't affect dangerous behavior in those who test negative but does increase condom use in individuals who test positive. 124 It is not known 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 quite an effective way to prevent HIV disease of their partner (a strategy called treatment as prevention, or TASP). Std Test nearest Shantytown Nevada United States. 125 TASP is related to 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 effective 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 may also be effective in intravenous drug users with a study finding a decrease in risk of 0.7 to 0.4 per 100personyears. 127

Current HAART options are blends (or "cocktails") consisting of at least three medications 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 analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs comprise: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Combinations of agents including protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in individuals of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it is advised that it's continued without breaks or "vacations". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desirable result of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is powerful are initially advocated after four weeks and once amounts 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 standards treatment is successful in more than 95% of folks during the very first year. 27

Advantages of treatment contain a reduced risk of departure and a decreased risk of progression to AIDS. Std Test near Shantytown Nevada. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a reduced danger of transmission to sexual partners of the disease and a decrease in mother-to-child transmission. 144 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 though price is an important problem with some drugs, 152 47% of people who desired them were taking them in low and middle income countries as of 2010 143 and also the speed of adherence is comparable in low income and high-income countries. 153

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