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The initial 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 infection can last from about three years 28 to over 20years 29 (on average, about eight years). 30 While commonly there are few or no symptoms in the beginning, near the end of the stage lots of people experience weight loss, fever, gastrointestinal difficulties and muscle pains. 1 Between 50 and 70% of individuals also develop persistent generalized lymphadenopathy , characterized by unexplained, non-painful enlargement of more than one group of lymph nodes (other than in the groin) for over three to six months. Std Test nearby Ship Bottom, New Jersey. Ship Bottom NJ Std Test. 2

Although most HIV 1 infected individuals have a detectable viral load and in the lack of treatment will eventually progress to AIDS, a small percentage (about 5%) retain 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 those who keep a low or undetectable viral load without antiretroviral treatment, known as "top-notch controllers" or "top-notch suppressors". They represent around 1 in 300 persons that are contaminated. Ship Bottom, 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 occurrence of specific disorders in association with an HIV infection. Std Test closest to Ship Bottom 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 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 individuals with HIV. 35 The second most common cancer is lymphoma, which is the cause of death of almost 16% of people with AIDS and is the first signal of AIDS in 3 to 4%. 35 Both these cancers are associated with human herpesvirus 8 35 Cervical cancer occurs more frequently in those with AIDS due to its association with human papillomavirus (HPV). 35 Conjunctival cancer (of the layer that lines the interior part of eyelids as well as 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 bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals 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 guys, with this specific public accounting for 67% of new cases and 83% of new cases among males over 12 years old. While 28 percent of transgender women test positive 49 About 15% of gay and bisexual men have HIV. 49 50 Std Test near me Ship Bottom.

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 nations. 51 In low income countries, 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 approximations for high income nations 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 homosexual contacts. 51 52 While the danger of transmission from oral sex is relatively low, it is still present. 53 The danger from getting oral sex was described as "nearly nil"; 54 nonetheless, a couple cases are reported. 55 The per-act risk is estimated at 0-0.04% for receptive oral sex. 56 In settings including 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 second most frequent way 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 threat from sharing a needle during drug shot is between 0.63 and 2.4% per action, with an average of 0.8%. Std test near NJ, 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 act and the danger 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 infected blood. 63 In developed countries the risk 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 example, in the UK the hazard 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 places come from transfusion of infected blood and blood products, representing between 5% and 10% of global diseases. Std Test closest to NJ United States. 11 68 Although rare because of screening, it is 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 causing infection in the baby. 73 74 This is the third most common manner in which HIV is transmitted internationally. 11 In the absence of treatment, the risk of transmission before or during birth is around 20% and in people 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 danger of mother-to-child infection may be reduced to about 1%. 73 Preventive treatment includes the mother avoiding 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 danger of transmission in people who do breastfeed. Many of these measures are nevertheless not obtainable in the developing world. 75 If food is contaminated by blood during pre- it might introduce a danger 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 accountable for long-duration sicknesses using an extended 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 (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 resulting viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host co-factors. 82 Once integrated, the virus might become latent, allowing the virus and its own host cell to prevent 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 start the replication cycle anew and new RNA genomes. 84

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HIV is now known to spread between CD4 T cells by two parallel courses: cell-free spread and cell-to-cell spread, i.e. it uses crossed propagating 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 process of cell-to-cell spread. Std Test near Ship Bottom, New Jersey. 86 87 The hybrid spreading mechanics of HIV contribute to the ongoing replication of the virus against antiretroviral therapies. 85 88

Following the virus enters the body there is a period of rapid viral replication, resulting in plenty 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 marked fall in the number of circulating CD4 T cells. The acute viremia is nearly invariably related to activation of CD8 T cells , which kill HIV-infected cells, and later with antibody generation, or seroconversion The CD8 T cell response 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 has been linked to slower disease progression as well as a better prognosis, though it doesn't eliminate 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 chronic 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 factor. During the chronic stage, the effects of generalized immune activation coupled with the gradual loss of the ability of the immune system to create 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 do not appear for years after an individual is infected, the bulk of CD4 T cell loss happens in the intestinal mucosa, which harbors the majority of the lymphocytes found within the body, particularly during the very first weeks of illness. 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 tiny 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 illness and seeks out. 98 A vigorous immune response eventually controls the infection and initiates the clinically latent stage. CD4 T cells in mucosal tissues stay especially changed. 98 Constant HIV replication causes a state of generalized immune activation prevailing throughout the long-term phase. 99 Immune activation, which is revealed by the increased activation state of immune cells and release of pro inflammatory cytokines, results from the action of several HIV gene products and the immune response to HIV replication that is continuing. Additionally it is 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

Ship Bottom, NJ Std Test. HIV/AIDS is diagnosed via laboratory testing and then staged on the basis of the presence of particular signs or symptoms 24 HIV screening is advised by the United States Preventive Services Task Force for all individuals 15years to 65years of age including all pregnant women. 101 Additionally, testing is suggested 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 just discover they are infected at an advanced stage of the disease when severe immunodeficiency or AIDS is now apparent. Std test closest to Ship Bottom NJ. 27

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Antibody evaluations in children younger than 18months are commonly wrong because of the continuing presence 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 dependable PCR testing and lots of places simply wait the child is old enough for antibody testing that is exact or until either symptoms grow. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the population were informed of their HIV status. Ship Bottom Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub-Saharan states were examined 103 which signified a considerable increase compared to preceding years. 103

Two principal clinical staging systems are used to classify HIV and HIV-related disorder 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 evaluations, it's suited to the resource-controlled states encountered in developing countries, where it can also be used 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 consistently 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 suggest that female condoms may provide an equal level of protection. Std test near Ship Bottom. 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 due to 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 2007 in regions with a high rates of HIV. 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 alternative and advocate for all sexually active heterosexual males. 118 Some experts fear that a lower perception of exposure among circumcised men may cause more sexual risk taking behavior, thus negating its preventive effects. 119

Plans encouraging sexual abstinence do not appear to influence subsequent HIV danger. 120 Signs of any gain from peer instruction is equally inferior. 121 Complete sexual education provided at school may fall high risk behaviour. 122 A substantial minority of young people continues to engage in high risk practices despite understanding about HIV/AIDS, underestimating their particular danger of becoming infected with HIV. Std Test nearby NJ, United States. 123 Voluntary counselling and testing people for HIV doesn't affect hazardous behaviour in those who test negative but does raise condom use in those who test positive. 124 It is not understood whether treating other sexually transmitted infections is effective in preventing HIV. 57

Antiretroviral treatment among individuals with HIV whose CD4 count 550 cells/L is quite an effective way to prevent HIV infection of their partner (a strategy called treatment as prevention, or TASP). Std test nearby Ship Bottom New Jersey 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 can also be successful in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART alternatives are combinations (or "cocktails") consisting of at least three medications belonging to at least two types, or "categories," of antiretroviral agents. 144 Initially treatment is typically a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs include: 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 mentioned regimen loses effectiveness. 144

United States and the World Health Organization recommends antiretrovirals in folks of all ages including pregnant women as soon as the investigation is made regardless of CD4 count. 14 118 146 Once treatment is started it's advised that it is continued without breaks or "holidays". 27 Many people are diagnosed just after treatment ideally should have begun. 27 The desired outcome of treatment is a long-term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is powerful are initially urged after four weeks and once degrees drop below 50copies/mL checks every three to six months are usually sufficient. 27 Insufficient control is deemed to be greater than 400copies/mL. 27 Based on these standards treatment is effective in more than 95% of people during the first year. 27

Advantages of treatment contain a decreased risk of death as well as a reduced risk of progression to AIDS. Std Test in Ship Bottom New Jersey. Physical and mental health also improves. 148 With treatment there is a 70% reduced risk of acquiring tuberculosis. 144 Additional benefits include a reduced risk of transmission to sexual partners of the disease as well as a decrease in mother-to-child transmission. 144 The effectiveness of treatment depends to a big part on conformity. 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 medications, 152 47% of those who wanted them were taking them in low and middle income nations as of 2010 143 and the rate of adherence is similar in low-income and high income states. 153

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