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The first symptoms are followed by a stage called continual HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase of the natural history of HIV disease can continue 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, close to the end of the period a lot of people experience gastrointestinal problems, weight loss, fever 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 groin) for over three to six months. Std test in Absecon Highlands New Jersey. Absecon Highlands NJ 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 tiny percentage (about 5%) retain elevated rates 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 people who keep a low or undetectable viral load without antiretroviral treatment, known as "elite controllers" or "elite suppressors". They represent approximately 1 in 300 individuals that are contaminated. Absecon Highlands New Jersey 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 disease. Std Test near Absecon Highlands New Jersey United States. 26 In the absence of particular treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most often occurring first conditions that alert 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 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 people with HIV. 35 The second most common cancer is lymphoma, that is the cause of death of nearly 16% of people who have AIDS and is the first hint of AIDS in 3 to 4%. 35 Both these cancers are linked with 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 inner part of eyelids and also the white portion 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 worldwide occur through heterosexual contacts (i.e. sexual contacts between people of the opposite sex); 11 yet, the pattern of transmission varies significantly among countries. As of 2014, most HIV transmission in America occurred among men who had sex with men, with this specific population accounting for 67% of new cases and 83% of new cases among males over 12 years old. 49 About 15% of homosexual and bisexual men have HIV while 28 percent of transgender women test positive. 49 50 Std Test closest to Absecon Highlands.

With regard 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 nations, the threat of female to male transmission is estimated as 0.38% per act, and of male-to-female transmission as 0.30% per action; the equivalent estimates for high income states 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 homosexual contacts. 51 52 While the risk of transmission from oral sex is comparatively low, it is still present. 53 The danger from receiving oral sex has been described as "almost nil"; 54 nevertheless, 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 act. 51

The 2nd most frequent 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 infected 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 nearest NJ, 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 hazard following mucous membrane exposure to infected blood as 0.09% (about 1 in 1000) per action. 47 In America intravenous drug users made up 12% of all new cases of HIV in 64, 2009 and in some places 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 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 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 appropriately screened (as of 2008), 67 and it's estimated that up to 15% of HIV infections in these regions come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std Test nearby NJ, 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 resulting in infection in the baby. 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 individuals who also 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 involves the mom taking antiretrovirals during pregnancy and delivery, an elective caesarean section, avoiding breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by the mother or the infant decline the risk of transmission in people who do breastfeed. 76 Many of these measures are yet not available in the developing world. 75 If blood contaminates food during pre- it might introduce a danger 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 sicknesses with a long incubation period 81 Lentiviruses are transmitted as single stranded, positive- sense , enveloped RNA viruses Upon entrance 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 consequent viral DNA is subsequently 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 the virus and its host cell to prevent detection by the immune system. 83 Instead, 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 begin the replication cycle over. 84

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HIV is now known to disperse between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it applies hybrid spreading 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 nearest Absecon Highlands, New Jersey. 86 87 The hybrid distributing mechanisms of HIV contribute to the virus's on-going replication against antiretroviral therapies. 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 response is accompanied by a marked 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 production, or seroconversion The CD8 T cell reaction is considered to be significant in controlling virus degrees, which peak and then decline, as the CD4 T cell counts recover. A good CD8 T cell response was linked to a better prognosis along with slower disease progression, though it will not get rid of the virus. 92

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Finally, 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 cancerous cells. The mechanism of CD4 T cell depletion differs in the long-term 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 decrease in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for years after an individual is infected, the majority of CD4 T cell loss occurs during the first weeks of illness, particularly in the intestinal mucosa, which harbors nearly all the lymphocytes found within the body. 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 gain access to the cells, whereas merely 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 seeks out and destroys CCR5 expressing CD4 T cells during acute illness. The infection is eventually controlled by 98 A vigorous immune response and begins the clinically latent period. CD4 T cells in mucosal tissues remain especially changed. 98 Continuous HIV replication causes a state of generalized immune activation persisting throughout the long-term period. 99 Immune activation, which is represented by the increased activation state of immune cells and release of proinflammatory cytokines, results from the activity of the immune response and also 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 caused by the depletion of mucosal CD4 T cells during the acute phase of disease. 100

Absecon Highlands, NJ std test. HIV/AIDS is diagnosed via laboratory testing and then staged based on the existence of certain signs or symptoms 24 HIV screening is recommended by the United States Preventive Services Task Force for all people 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 just discover they're infected at an advanced phase of the disease when AIDS or acute immunodeficiency has become evident. Std Test near me Absecon Highlands NJ. 27

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Antibody tests in kids younger than 18months are normally erroneous because of the continued existence of maternal antibodies 102 Consequently 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 lots of places just wait until either symptoms grow or the child is old enough for accurate antibody testing. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the public were aware of their HIV status. Absecon Highlands Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which represented a considerable increase compared to preceding years. 103

Two chief clinical staging systems are used to classify HIV and HIV-associated disease for surveillance goals: the WHO disease staging system for HIV infection and disease , 24 along with 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 doesn't require laboratory evaluations, it is suited to the resource-controlled conditions encountered in developing countries, where it may also be utilized to help direct clinical management. Despite their differences, both systems enable 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 by a couple in which one person is infected, the rate of HIV infection is less than 1% per year. 107 There is some evidence to suggest that female condoms may provide an equal degree of protection. Std test nearby Absecon Highlands. 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 increase the risk of transmission due to its inclination 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 the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female-to-male HIV transmission in 2007 in regions with a high rates of HIV. 112 However, whether it protects against male to female transmission is challenged, 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 recommend for all sexually active heterosexual males and that it be discussed as an option with men who have sex with men. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behavior, hence negating its prophylactic effects. 119

Plans supporting sexual abstinence do not appear to affect subsequent HIV risk. 120 Evidence of any gain from peer instruction is equally inferior. High risk behaviour may be decreased by 121 Comprehensive 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 danger of becoming infected with HIV. Std test nearby NJ United States. 123 Voluntary counseling and testing individuals for HIV will not influence dangerous behavior in those who test negative but does raise 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 a very productive method to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test near me Absecon Highlands New Jersey United States. 125 TASP is associated 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 effective in several groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It may also be effective in intravenous drug users using a study finding a reduction in danger of 0.7 to 0.4 per 100personyears. 127

Present HAART options are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "categories," of antiretroviral agents. 144 Initially therapy is commonly 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 Mixtures of agents which include protease inhibitors (PI) are used if the above regimen loses effectiveness. 144

United States and the World Health Organization advocates 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 is recommended that it is continued without breaks or "vacations". 27 Many individuals 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 successful are initially urged after four weeks and once degrees drop below 50copies/mL tests every three to six months are generally adequate. 27 Inadequate control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of individuals during the very first year. 27

Advantages of treatment include a reduced risk of departure as well as a decreased risk of progression to AIDS. Std Test in Absecon Highlands New Jersey. Physical and mental health also enhances. 148 With treatment there is a 70% reduced risk of getting tuberculosis. 144 Added benefits include a reduced danger of transmission to sexual partners of the disease as well as a drop in mom-to-child transmission. The effectiveness of treatment depends to a large 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 Even though price is an important issue with some medicines, 152 47% of people who desired them were taking them in the speed of adherence and middle and low income countries as of 2010 143 is comparable in low income and high income nations. 153

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