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The initial symptoms are followed by a period called clinical latency, asymptomatic HIV, or persistent HIV. 1 Without treatment, this second phase of the natural history of HIV infection can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While usually there are few or no symptoms initially, close to the end of this phase a lot of people experience fever, weight loss, gastrointestinal problems and muscle pains. 1 Between 50 and 70% of individuals also grow persistent generalized lymphadenopathy , characterized 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 me Eaton Center, New Hampshire. Eaton Center NH 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 small proportion (about 5%) keep high amounts 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 keep a low or undetectable viral load without anti-retroviral treatment, known as "elite controllers" or "elite suppressors". They represent around 1 in 300 individuals that are infected. Eaton Center, New Hampshire 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 infection. Std Test near Eaton Center New Hampshire United States. 26 In the lack of particular treatment, around half of people infected with HIV develop AIDS within ten years. 26 The most common initial conditions that alarm to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the type of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have an increased 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 typical cancer occurring in 10 to 20% of people with HIV. 35 The second most common cancer is lymphoma, that is the initial hint of AIDS in 3 to 4% and is the cause of death of almost 16% of people with AIDS. 35 Both these cancers are associated 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 interior part of eyelids and also the white portion 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 majority of all transmissions globally occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 however, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with guys, with this specific 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 closest to Eaton Center.

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 countries, 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 states 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 relatively low, it's still present. 53 The danger from getting oral sex was described as "almost nil"; 54 nonetheless, 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 was estimated as 2.4% per action and male-to-female transmission as 0.05% per act. 51

The 2nd most common mode 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 injections with unsterilized equipment. The threat from sharing a needle during drug shot is between 0.63 and 2.4% per act, with an average of 0.8%. Std test in NH 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 action. 47 In the USA intravenous drug users made up 12% of all new cases of HIV in 64 2009 and in a few areas more than 80% of individuals who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the risk of getting 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 risk 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 is 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 nearby NH, United States. 11 68 Although rare due to screening, it really is 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 resulting in infection in the infant. 73 74 This is the third most common way in which HIV is transmitted internationally. 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 appropriate treatment the danger of mother-to-child infection could be reduced to about 1%. 73 Preventive 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 baby decline the danger of transmission in those who do breastfeed. 76 Many of these measures are yet not accessible the developing world. 75 If blood contaminates food 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 features. Many species of mammals are infected by lentiviruses, which are characteristically responsible for long-duration illnesses with 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 is transported together 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 co-factors. 82 Once incorporated, the virus may become latent, allowing its host cell and the virus to avoid detection by the immune system. 83 Alternatively, the virus could be transcribed, generating new RNA genomes and viral proteins which are packaged and released from the cell as new virus particles that start the replication cycle anew. 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 employs crossed spreading 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 can also disseminate by direct transmission from one cell to another by a procedure for cell-to-cell spread. Std test in Eaton Center New Hampshire. 86 87 The hybrid dispersing mechanics of HIV contribute to the virus's on-going replication against antiretroviral treatments. 85 88

There's a period of rapid viral replication, resulting in plenty of virus in the peripheral blood after the virus enters the body. During primary infection, the amount 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 later with antibody production, or seroconversion The CD8 T cell reaction is regarded as important in controlling virus amounts, which peak and then decline, as the CD4 T cell counts recover. A CD8 T cell response that was good was linked to slower disease progression as well as a better prognosis, though it does not 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 crucial to the immune response 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 might also be a variable. 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 seem 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 someone is infected, the majority of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found within the body, especially during the very first weeks of infection. 95 The reason for 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 access the cells, whereas only a small 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 seeks out and destroys CCR5 expressing CD4 T cells during acute illness. 98 A vigorous immune response eventually controls the infection and begins the clinically latent stage. CD4 T cells in mucosal tissues remain particularly changed. 98 Continuous 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 action of the immune response as well as several HIV gene products to continuing 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

Eaton Center, NH Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the presence 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 recommended for those at high risk, which comprises anyone diagnosed with a sexually transmitted illness. 27 In many regions of the world, a third of HIV carriers simply find when severe immunodeficiency or AIDS is now clear they're infected at an advanced phase of the disorder. Std test nearest Eaton Center, NH. 27

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Antibody evaluations in kids younger than 18months are normally erroneous because of the ongoing presence of maternal antibodies 102 Thus 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 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 inhabitants were informed of their HIV status. Eaton Center std test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were tested 103 which represented a substantial increase compared to previous years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated disease 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 often adopted in developed countries. Since the WHO 's staging system does not need lab tests, it is satisfied to the resource-restricted conditions encountered in developing countries, where it may also be used to help direct clinical management. Despite their differences, the two systems permit comparison for statistical purposes. 2 24 104

Consistent condom use reduces the danger of HIV transmission by approximately 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 equal level of protection. Std Test nearest Eaton Center. 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 increase the risk of transmission because of its tendency 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 the World Health Organization and UNAIDS advocated male circumcision as a way of preventing female-to-male HIV transmission in regions with a high rates of HIV in 2007. 112 Nonetheless, whether it protects against male to female transmission is disputed, 113 114 and whether it is of advantage in developed nations and among men who have sex with men is undetermined. 115 116 117 The International Antiviral Society, nevertheless, does that it be discussed with men who have sex with men as an alternative and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower perception of vulnerability among circumcised men may cause more sexual risk-taking behaviour, thereby negating its prophylactic effects. 119

Programs encouraging sexual abstinence don't seem to impact subsequent HIV danger. 120 Evidence of any benefit from peer education is equally inferior. High risk behaviour may be decreased by 121 Complete sexual education provided at school. 122 A substantial minority of young people continues to engage in high risk practices despite knowing about HIV/AIDS, underestimating their own risk of becoming infected with HIV. Std Test nearest NH, United States. 123 Voluntary counseling and testing individuals for HIV will not affect hazardous behavior in those who test negative but does increase condom use in individuals who test positive. 124 It isn't known 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 an extremely productive method to prevent HIV infection of their partner (a strategy known as treatment as prevention, or TASP). Std Test near me Eaton Center New Hampshire United States. 125 TASP is connected with a 10 to 20 fold reduction in transmission risk. 125 126 Pre-exposure prophylaxis (PrEP) with a daily dose of the medications 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 can also be successful in intravenous drug users with a study finding a drop in risk of 0.7 to 0.4 per 100personyears. 127

Present HAART options are blends (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "groups," of antiretroviral agents. 144 Initially treatment is commonly a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analog reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs include: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Blends of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

The World Health Organization and United States urges antiretrovirals in people of all ages including pregnant women as soon as the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is started it's recommended that it's continued without breaks or "vacations". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desired result of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Degrees to determine if treatment is successful are initially advocated 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 criteria treatment is effective in more than 95% of people during the first year. 27

Advantages of treatment include a reduced danger of departure and a reduced risk of progression to AIDS. Std test nearest Eaton Center, New Hampshire. Mental and physical health also enhances. 148 With treatment there's a 70% reduced risk of getting tuberculosis. 144 Added benefits include a decreased danger of transmission of the illness to sexual partners and a decrease in mom-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 27 Rationales 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 though cost is an important problem with some drugs, 152 47% of people who desired they were being taken by them in the rate of adherence and also low and middle income nations as of 2010 143 is comparable in low-income and high income countries. 153

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