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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 around three years 28 to over 20years 29 (on average, about eight years). 30 While typically there are few or no symptoms in the beginning, near the end of this period many 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 crotch) for over three to six months. Std test near me New Ipswich New Hampshire. New Ipswich, NH 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 small 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 controllers or long term nonprogressors (LTNP). 31 Another group consists of people who maintain a low or undetectable viral load without anti retroviral treatment, known as "elite controllers" or "elite suppressors". They represent about 1 in 300 individuals that are contaminated. New Ipswich 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 incidence of specific disorders in association with an HIV infection. Std Test nearby New Ipswich New Hampshire United States. 26 In the absence 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 existence 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

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 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 almost 16% of individuals with AIDS and is the initial sign of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more often 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 and the white part of the eye) is also more common 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 pattern of transmission varies significantly among states. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this public accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of gay and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std test near me New Ipswich.

With respect to unprotected heterosexual contacts, approximations of the risk 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 danger 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 estimates 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 especially high, estimated as 1.4-1.7% per act 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 risk from receiving oral sex has been described as "nearly nil"; 54 nonetheless, a couple instances have been reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral intercourse. 56 In settings involving 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 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 during intravenous drug use, needle stick injury, transfusion of infected 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 NH, United States. 63 The danger of getting HIV from a needle stick from an HIV-infected individual is estimated as 0.3% (about 1 in 333) per action and the risk 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 some places 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 danger 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 suitably screened (as of 2008), 67 and it is estimated that up to 15% of HIV infections in these areas come from transfusion of contaminated blood and blood products, representing between 5% and 10% of global infections. Std test near NH, United States. 11 68 Although rare because of screening, it is likely to get HIV from organ and tissue 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 infant. 73 74 This is the third most common way in which HIV is transmitted internationally. 11 In the lack of treatment, the danger of transmission before or during birth is around 20% and in those 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 danger of mother-to-child infection may be reduced to about 1%. 73 Preventive treatment includes the mother preventing 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 baby decline the risk of transmission in those who do breastfeed. 76 Many of these measures are however not available in the developing world. 75 If food is contaminated by blood during pre- it may present 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 in charge of long-duration illnesses with 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 (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 resultant 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 may become latent, allowing the virus and its host cell to avoid detection by the immune system. 83 Instead, the virus may be transcribed, creating viral proteins that 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 understood to spread between CD4 T cells by two parallel courses: cell free spread and cell-to-cell spread, i.e. it employs hybrid propagating 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 process of cell-to-cell spread. Std test closest to New Ipswich New Hampshire. 86 87 The hybrid distributing mechanics of HIV contribute to the virus's continuing replication against antiretroviral therapies. 85 88

Following the virus enters the body there's a period of rapid viral replication, resulting in an abundance of virus in the peripheral blood. During primary infection, the degree 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 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 degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response has been linked to a better prognosis and also slower disease progression, though it doesn't remove the virus. 92

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Ultimately, HIV causes AIDS by depleting CD4 T cells the immune system weakens and allows opportunistic infections T cells are crucial 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 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 might also be a variable. During the chronic phase, the effects 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

While the symptoms of immune deficiency feature of AIDS do not appear for a long time after a person is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors most of the lymphocytes found within the body, particularly during the very first weeks of illness. 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 tiny 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 disease and seeks out. 98 A vigorous immune response eventually controls the infection and begins the clinically latent phase. CD4 T cells in mucosal tissues remain especially affected. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term stage. 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 as well as several HIV gene products to continuing HIV replication. It's 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

New Ipswich 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 recommended by the United States Preventive Services Task Force for all folks 15years to 65years old including all pregnant women. 101 Moreover, testing is suggested for those at high risk, which comprises anyone. 27 In many regions of the planet, a third of HIV carriers simply discover when AIDS or severe immunodeficiency is now evident they are infected at an advanced phase of the disorder. Std test in New Ipswich, NH. 27

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Antibody evaluations in kids younger than 18months are generally erroneous due to the ongoing presence of maternal antibodies 102 Hence 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 places simply wait until either symptoms grow or the child is old enough for antibody testing that is exact. 102 In sub Saharan Africa as of 2007-2009 between 30 and 70% of the population were aware of their HIV status. New Ipswich Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were tested 103 which signified a substantial increase compared to preceding years. 103

Two main clinical staging systems are used to classify HIV and HIV-associated ailment for surveillance goals: the WHO disorder 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 doesn't require lab evaluations, it is satisfied to the resource-controlled states encountered in developing countries, where it can also be used to help guide 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's some evidence to suggest that female condoms may provide an equal degree of protection. Std Test near me New Ipswich. 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 rectal and vaginal 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 UNAIDS and the World Health Organization recommended male circumcision as a way of preventing female to male HIV transmission in areas using a high rates of HIV in 2007. 112 Nonetheless, 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 that it be discussed with men who have sex with men as an option and recommend for all sexually active heterosexual males. 118 Some experts worry that a lower understanding of exposure among circumcised men may cause more sexual risk-taking behavior, hence negating its prophylactic effects. 119

Plans encouraging sexual abstinence do not seem to impact subsequent HIV danger. 120 Signs of any gain from peer instruction is equally inferior. 121 Complete sexual education provided at school may decrease high risk behavior. 122 A large minority of young people continues to participate in high-risk practices despite knowing about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test closest to NH, United States. 123 Voluntary counselling and testing individuals for HIV will not influence risky behavior in those who test negative but does increase condom use in those 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 a very productive way to prevent HIV disease of their partner (a strategy referred to as treatment as prevention, or TASP). Std test near me New Ipswich New Hampshire, United States. 125 TASP is connected with 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 successful in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be successful in intravenous drug users using a study finding a decrease in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART choices are mixtures (or "cocktails") consisting of at least three medications belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially therapy is generally 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 Combinations of agents which include protease inhibitors (PI) are used if the aforementioned regimen loses effectiveness. 144

United States and the World Health Organization advocates antiretrovirals in folks of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 After treatment is begun it's advised that it is continued without breaks or "holidays". 27 Many people are diagnosed only after treatment ideally should have begun. 27 The desirable outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to determine if treatment is successful are initially urged 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

Advantages of treatment contain a reduced danger of departure and also a decreased risk of progression to AIDS. Std Test in New Ipswich New Hampshire. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added benefits include a reduced risk of transmission of the disease to sexual partners as well as a drop in mother-to-child transmission. 144 The effectiveness of treatment depends to a large part on compliance. 27 Rationales 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 though price is an important problem with some medicines, 152 47% of people who desired them were taking them in the rate of adherence and also middle and low income nations as of 2010 143 is comparable in low-income and high-income states. 153

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