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The first symptoms are followed by a period called chronic HIV, asymptomatic HIV, or clinical latency. 1 Without treatment, this second phase 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 generally there are no or few symptoms in the beginning, close to the end of this stage a lot of people experience fever, weight loss, gastrointestinal problems 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 nearby West Berlin New Jersey. West Berlin, 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 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 antiretroviral treatment, known as "elite controllers" or "top-notch suppressors". They represent approximately 1 in 300 contaminated persons. West Berlin, 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 diseases in association with an HIV infection. Std Test near West Berlin New Jersey, United States. 26 In the absence of specific treatment, around half of individuals infected with HIV develop AIDS within ten years. 26 The most common first conditions that alarm to the presence of AIDS are pneumocystis pneumonia (40%), cachexia in the kind of HIV wasting syndrome (20%), and esophageal candidiasis 26 Other common signs include recurring respiratory tract infections 26

Individuals with AIDS have a higher 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, which is the initial hint of AIDS in 3 to 4% and is the cause of death of nearly 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 due to 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 common mode of transmission of HIV is through sexual contact with an infected person. 11 The bulk of all transmissions worldwide occur through heterosexual contacts (i.e. sexual contacts between individuals of the opposite sex); 11 nevertheless, the pattern of transmission varies significantly among nations. As of 2014, most HIV transmission in America occurred among men who had sex with men, 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 homosexual and bisexual guys have HIV. 49 50 Std test nearest West Berlin.

With respect to unprotected heterosexual contacts, estimates of the danger of HIV transmission per sexual act appear 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 particularly high, estimated as 1.4-1.7% per action in both heterosexual and gay contacts. 51 52 While the risk of transmission from oral sex is relatively low, it is still present. 53 The risk from getting oral sex was described as "almost nil"; 54 yet, a few cases have been 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 action and male to female transmission as 0.05% per act. 51

The next 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 contaminated 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 act, with an average of 0.8%. Std Test near me NJ United States. 63 The risk 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 threat following mucous membrane exposure to infected 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 64, 2009 and in certain regions more than 80% of people who inject drugs are HIV positive. 11

HIV is transmitted in about 93% of blood transfusions using infected blood. 63 In developed nations the danger 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 united kingdom 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 regions come from transfusion of contaminated 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 is 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 causing infection in the baby. 73 74 This is the third most common manner in which HIV is transmitted worldwide. 11 In the lack of treatment, the risk of transmission before or during birth is around 20% and in those who also breastfeed 35%. 73 As of 2008, vertical transmission accounted for about 90% of cases of HIV in children. 73 With proper treatment the risk of mother-to-child infection could be reduced to about 1%. 73 Preventative treatment includes the mother taking antiretrovirals during pregnancy and delivery, an elective caesarean section, preventing breastfeeding, and administering antiretroviral drugs to the newborn. 75 Antiretrovirals when taken by either the mother or the infant decrease the risk of transmission in people who do breastfeed. Many of these measures are nevertheless not accessible the developing world. 75 If blood contaminates food during pre- chewing it might present a risk of transmission. 71

HIV is an associate 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 in charge of long-duration sicknesses 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's transported together with the viral genome in the virus particle. The resultant viral DNA is then imported into the cell nucleus and integrated into the cellular DNA by a virally encoded integrase and host cofactors. 82 Once incorporated, the virus might become latent, enabling its own host cell and the virus to avoid 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 afresh. 84

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HIV is now understood to distribute between CD4 T cells by two parallel paths: cell free spread and cell-to-cell spread, i.e. it uses hybrid 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 closest to West Berlin, New Jersey. 86 87 The hybrid spreading mechanics of HIV lead to the virus's continuing replication against antiretroviral treatments. 85 88

There is a period of rapid viral replication, leading to an abundance 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 response is accompanied by a noticeable fall 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 afterwards with antibody generation, 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 associated with 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 critical to the immune response and without them, the body cannot fight illnesses or kill cancerous cells. 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 may also be a variable. During the chronic phase, the consequences of generalized immune activation coupled with the gradual loss of the ability of the immune system to create new T cells appear to account for the slow decline in CD4 T cell numbers. 94

While the symptoms of immune deficiency characteristic of AIDS don't appear for years after someone is infected, the bulk of CD4 T cell loss occurs in the intestinal mucosa, which harbors the majority of the lymphocytes found in the body, particularly during the first weeks of disease. 95 The reason behind the preferential loss of mucosal CD4 T cells is that nearly all mucosal CD4 T cells express the CCR5 protein which HIV uses as a co-receptor to obtain access to the cells, whereas merely 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. The disease is eventually controlled by 98 A vigorous immune response and begins the clinically latent period. CD4 T cells in mucosal tissues remain particularly changed. 98 Constant HIV replication causes a state of generalized immune activation continuing throughout the chronic period. 99 Immune activation, which is reflected by the increased activation state of immune cells and release of pro-inflammatory cytokines, results from the action of several HIV gene products and also the immune response to continuing HIV replication. It's also linked to the dysfunction of the immune surveillance system of the gastrointestinal mucosal barrier resulting from the depletion of mucosal CD4 T cells during the acute phase of disease. 100

West Berlin, 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 advocated by the United States Preventive Services Task Force for all individuals 15years to 65years old including all pregnant women. 101 Moreover, testing is recommended for those at high risk, which comprises anyone. 27 In many regions of the planet, a third of HIV carriers only discover when acute immunodeficiency or AIDS has become clear, they're infected at an advanced stage of the disease. Std Test closest to West Berlin NJ. 27

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Antibody evaluations in children younger than 18months are commonly wrong because of the continued existence of maternal antibodies 102 Hence 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 trusted PCR testing and several areas just wait the child is old enough for precise antibody testing or until either symptoms develop. 102 In sub-Saharan Africa as of 2007-2009 between 30 and 70% of the inhabitants were informed of their HIV status. West Berlin Std Test. 103 In 2009, between 3.6 and 42% of men and women in Sub Saharan states were analyzed 103 which signified a substantial increase compared to previous years. 103

Two chief clinical staging systems are used to classify HIV and HIV-related disease 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 adopted in developed nations. Since the WHO 's staging system doesn't require laboratory tests, it is suited to the resource-restricted states encountered in developing countries, where it can be used to help direct clinical management. Despite their differences, both systems enable comparison for statistical purposes. 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 person 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 equivalent level of protection. Std test nearby West Berlin. 108 Application of a vaginal gel containing tenofovir (a reverse transcriptase inhibitor ) immediately before sex seems to lessen infection rates by about 40% among African women. 109 By contrast, use of the spermicide nonoxynol-9 may raise the risk of transmission due to its tendency to cause vaginal and rectal 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, both the World Health Organization and UNAIDS recommended male circumcision as a method of preventing female to male HIV transmission in places with a high rates of HIV in 2007. 112 Yet, whether it protects against male-to-female transmission is challenged, 113 114 and whether it's of benefit 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 advocate for all sexually active heterosexual males. 118 Some experts fear that a lower understanding of vulnerability among circumcised men may cause more sexual risk-taking behavior, hence negating its preventative effects. 119

Programs supporting sexual abstinence don't seem to affect subsequent HIV risk. 120 Evidence of any benefit from peer instruction is equally inferior. 121 Comprehensive sexual education provided at school may decrease high risk behaviour. 122 A substantial minority of young people proceeds to engage in high risk practices despite understanding about HIV/AIDS, underestimating their particular risk of becoming infected with HIV. Std Test nearby NJ United States. 123 Voluntary counseling and testing people for HIV will not affect hazardous behaviour in those who test negative but does increase condom use in those who test positive. 124 It is not understood 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 method to prevent HIV infection of their partner (a strategy referred to as treatment as prevention, or TASP). Std Test nearest West Berlin New Jersey, United States. 125 TASP is related to 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 a number of groups including men who have sex with men, couples where one is HIV positive, and youthful heterosexuals in Africa. 109 It might also be effective in intravenous drug users using a study finding a drop in danger of 0.7 to 0.4 per 100personyears. 127

Current HAART choices are combinations (or "cocktails") consisting of at least three drugs belonging to at least two kinds, or "classes," of antiretroviral agents. 144 Initially therapy is usually a non-nucleoside reverse transcriptase inhibitor (NNRTI) plus two nucleoside analogue reverse transcriptase inhibitors (NRTIs). 145 Typical NRTIs contain: zidovudine (AZT) or tenofovir (TDF) and lamivudine (3TC) or emtricitabine (FTC). 145 Mixtures of agents including protease inhibitors (PI) are used if the above mentioned regimen loses effectiveness. 144

The World Health Organization and United States recommends antiretrovirals in people of all ages including pregnant women when the diagnosis is made regardless of CD4 count. 14 118 146 Once treatment is begun it's advised that it's continued without breaks or "holidays". 27 Many individuals are diagnosed only after treatment ideally should have started. 27 The desirable outcome of treatment is a long term plasma HIV-RNA count below 50copies/mL. 27 Levels to find out if treatment is successful are initially recommended after four weeks and once levels fall below 50copies/mL checks every three to six months are generally sufficient. 27 Inadequate 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 include a decreased danger of death and also a decreased risk of progression to AIDS. Std Test in West Berlin New Jersey. 147 In the developing world treatment also improves mental and physical health. 148 With treatment there's a 70% reduced risk of acquiring tuberculosis. 144 Additional advantages include a decreased risk of transmission of the illness to sexual partners and also a decrease in mother-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 problem with some medications, 152 47% of those who needed they were being taken by them in low and middle income countries as of 2010 143 and also the rate of adherence is similar in low-income and high-income nations. 153

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