Early Hiv Test Accuracy

It's a good step that you've undergone an hiv rna pcr test for early detection after a potential exposure. Typically, these tests are designed to detect both hiv-1 and hiv-2, unless specified otherwise. An undetected result after 12 days is a positive sign, but it's important to consider a few factors. 1. Hiv types: the hiv rna pcr test is generally inclusive of both hiv-1 and hiv-2, covering the most common types of the virus. However, the prevalence of hiv-2 is lower than hiv-1, especially outside specific regions like west africa. 2. Window period: the term "window period" refers to the time it takes for the virus to be detectable in the blood. While rna pcr tests are highly sensitive, there is still a window period. Early testing is encouraging, but follow-up testing may be recommended to ensure accuracy. 3. Regional considerations: if you haven't been in regions where hiv-2 is more prevalent, the likelihood of being infected with hiv-2 is generally lower. Still, you may opt for specialized test which target hiv-2. To provide more accurate guidance, it would be beneficial to review the actual test report. I encourage you to share the report image in a private chat within the platform. This will allow for a more detailed discussion and personalized advice based on your specific situation. Regular follow-ups and ongoing communication contribute significantly to the accurate interpretation of hiv test results and overall health management. 

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Dr. Prakhar SinghMBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)General Physician

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I am sorry to hear about your concern but will be happy to assist you. Yes. Modern hiv tests are very accurate. This accuracy has to be considered with the window period. For example, 4th generation tests will pick up 99% of infections at six week. Testing earlier, for example after four week, only detects 95% of infections let's connect over a call so that we can discuss your concern in details and make a suitable treatment plan for you. 

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Dr. Prakhar SinghMBBS, Basic Life Support (B.L.S), Advanced Cardiac Life Support, Fellow of Academy of General Education (FAGE)General Physician

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I am sorry to hear about your concern but will be happy to assist you. Yes. Modern hiv tests are very accurate. This accuracy has to be considered with the window period. For example, 4th generation tests will pick up 99% of infections at six week. Testing earlier, for example after four week, only detects 95% of infections let's connect over a call so that we can discuss your concern in details and make a suitable treatment plan for you. 

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Dr. Rajesh DeshwalMD - Internal Medicine, Fellowship in HIV MedicineHIV Specialist

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You can ask for 4th generation ELISA or HIV RNA PCR after 3-4 weeks of exposure. 13 days is little too early for that test to pick up HIV. Best wishes. 

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Dr. Sujoy DasguptaMBBS (Gold Medalist, Hons), MS (Obst and Gynae- Gold Medalist), DNB (Obst and Gynae), Fellow- Reproductive Endocrinology and Infertility (ACOG, USA), FIAOG, MRCOG (London, UK)Gynaecologist

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We need to evaluate the cysts to know the type of the cysts. All cysts do not need operation. Please read the following article on IUI Introduction When couples get married, they often view parenthood as the next stage in their family life. They want to have a child, they want to be “mom” and “dad”, they cannot imagine that this may be hard to achieve or may not be a natural process. When several trials to conceive fail, they are shocked. Their basic expectation about family life gets shattered. Most of the couples are desperately looking for medical therapy that will end into a misery. Clearly this is not a struggle to survive; it is a struggle to fulfill a dream, to achieve what they view as a “full life”. What is needed for pregnancy? In the male partner, sperms are normally produced in the testes after puberty (after attainment of characters like growth of beard, moustache etc). From the testes, they are carried through the sperm conducting ducts (epididymis, vas, seminal vesicle and prostate gland). Then during sexual stimulation, after proper erection and ejaculation, they come out through penis. During sexual intercourse, these sperms, present in semen, are deposited inside the vagina. In female partner, the deposited sperms must travel from vagina through the cervix (the mouth of the uterus). The cervix acts as gate-keeper, a it prevents entry of dead and abnormal sperms as well as bacteria present in semen, in the uterus. From uterus, sperms reach the Fallopian tubes (the tubes that are attached to the both sides of the uterus) where the sperms must meet the egg (ovum). The eggs are produced only before birth and so, there are fixed number of eggs inside the ovary. The ovum released from the ovary, into the abdomen at the time of ovulation (rupture of the surface of ovary to release the ovum). That ovum must be taken by the tube and thus inside the tube an embryo (earliest form of the baby) is formed, by meeting of the egg and the sperm. It should be mentioned that out of nearly 200-300 million sperms, in average, deposited in vagina, hardly 500- 800 sperms can reach near the eggs and only one will succeed to form the embryo. The embryo then travels through the tube into the uterus and the uterus attaches the embryo firmly with it and thus the pregnancy starts. So, if there is defect in any one of them there will be difficulty in achieving pregnancy. Thus, to summarise, pregnancy requires 1.Production of healthy (“Normal Morphology”) and movable (“Normal Motility”) sperms in adequate number (“Normal Count”) in the testes 2.Transport of these sperms through the sperm conducting ducts from testes to penis 3.Successful Erection and Ejaculation during Intercourse to deposit adequate number of these sperms in the vagina 4.Transport of these sperms from vagina through cervix to the uterus and the tubes 5.Presence of sufficient number of eggs inside the ovary and ability to release the eggs from the ovaries 6.Pick up of the eggs by the tubes 7.Approximation of eggs and the sperms to form the embryo 8.Transport of embryo from the tubes into the uterus 9.Acceptance of the embryo by the uterus and its growth What is Infertility? Literally, the word “Infertility” means inability to conceive. But in reality, there are very few couples, who have no chance of natural conception and are called “Absolutely Infertile”. In fact, in many couples who present to infertility clinics, pregnancy may be the matter of time, thus the chance factor. It should be kept in mind that, if there is factors to question fertility of either male or female or the female is of age less than 35 years; after one cycle (one month) of regular frequent intercourse, the chance of conception in human being is only 15%. That means, out of 100 couples trying for conception, only 15 will be able to succeed after one month of trying. The word “Regular” and “Frequent” are important; because to achieve pregnancy, couples are advised to keep intimate relationships for at least 2-3 times a week and this should be increased particularly around the time of ovulation (Middle of the menstrual cycle). Thus chance of pregnancy after 6 months, 12 months and 24 months of regular trying are respectively 60%, 80% and 100%. The word, “Subfertility” seems better and more scientific than “Infertility”, to describe the couples who have reduced chance of conception, due to any cause. However, the word “Infertility”, seems more popular, although it puts pressure on the couples. In most cases, usually we advise to investigate after one year of regular and frequent intercourse, when the couples fail to conceive. However, if there are factors to question fertility; for example female with age more than 35 years, or with previous surgery in tubes/ ovaries/ uterus or known diseases like PCOS or endometriosis; or male partner having surgery in scrotum or groin or any hormonal problems or sexual dysfunctions- the wait period is usually reduced and couples can be investigated, even soon after marriage. What causes Infertility? Please look at the point “Thus, to summarise, pregnancy requires” where 9 points have been mentioned. Thus the common causes may be 1.Problems in male- total absence of production of sperms, less than adequate number of sperms, problems in morphology and motility of sperms (most sperms not healthy or movable), blockage in transport of sperms and inability to deposit sperms in the vagina (sexual dysfunction- Erectile Dysfunction or less commonly, Ejaculatory Dysfunction). Examples include hormonal problems (Testosterone, thyroid, prolactin), diabetes, liver problems, causes present since birth, chromosomal abnormalities, surgery, infection, sexually transmitted diseases, smoking, exposure of scrotum to high temperature, some medicines or psychological causes. 2.Problems in female- total absence of less than adequate number of eggs in the ovaries, problems in ovulation, problems in picking of eggs by the tubes, blockage of tubes, problems in conduction of sperms or embryo by the uterus, problems in accepting the embryos by the uterus. Examles include causes present since birth, chromosomal abnormalities, polycystic ovarian syndrome (PCOS), old age, increased weight, fibroid, endometriosis, pelvic inflammatory diseases (PID), tuberculosis (TB), infections, smoking, surgery, some medicines, hormonal problems (thyroid, prolactin) or excessive stress. 3.Unknown causes- Despite thorough investigations, 25-30% causes of infertility remain unknown. This is called “Unexplained Infertility”. The reason may be mere chance factors or there may be some causes which, still medical science has yet to discover. But this should be kept in mind while treating infertility. That means, even with correction of the possible factors (like improving sperm counts or thyroid problems etc) or with proper treatment (IUI, IVF or ICSI), unfortunately the treatment can fail and the exact reason, why the treatment failed, is sometimes difficult to find out. In general, what are the treatment options for infertility? To start with, please remember there is no hard and fast rules for infertility treatment. Often medical science fails to understand why couples with very severe form of infertility conceive sooner than those who are having all tests normal. That means, whatever treatment is offered, it’s very important to continue regular sexual intercourse, as the chance of natural pregnancy is usually there in almost all couples. Your doctor will present the facts to you, without pressurizing you on a particular option. After coming to know all pros and cons of different treatment options, you can take decision. Do not hurry. It’s quite natural that you might be in stress. In general, after the initial tests, a few periods of natural trying is allowed. After that, ovulation induction (giving medicines to release eggs from the ovaries) is offered, failing which IUI and finally IVF is offered. What will be the preferred treatment for you, will depend on your age, duration of marriage, male and female factors and of course, your age. For example, a woman with both tubes blocked or a male with very low sperm count, IVF would be the first line of treatment. What is insemination? Insemination literally means putting semen in a particular place. Various forms of insemination exist in fertility treatment. First one is “Intravaginal Insemination (IVI)”, where the raw semen, collected by the husband can be put inside the vagina, taking precautions (to prevent infection) by the husband himself or by the wife. Rarely, it needs medical assistance from a doctor. It’s usually advised to couples having sexual disorders where full penetrative intercourse is not possible (erectile dysfunction of the husband or very painful intercourse experienced by the wife) or where ejaculation cannot happen during intercourse (a very unusual problem). Thus, the success rate of IVI is no better than natural intercourse (success rate 15% per cycle), for those couples who can manage successful intercourse. “Intrauterine Insemination (IUI)” is the treatment where “prepared” semen is put inside the cavity of the uterus, near the Fallopian tubes. Thus, IUI bypasses some hurdles that can cause problems during natural intercourse. The vagina, cervix and the whole length of the uterus are bypassed, putting the sperms near the eggs. Thus it increases the success rate compared to natural intercourse or IVI. However, to achieve pregnancy after IUI, the female partner must have open tubes, adequate number of eggs produced by ovaries, eggs must be released by the ovaries and sperms must meet the eggs. And, thus nature plays important role, as in natural intercourse. Please note, we used the word “prepared” semen. In natural intercourse, as mentioned earlier, the dead sperms and bacteria cannot enter the uterus, because cervix prevents their entry. If they are put artificially by IUI inside the uterus, severe reaction can happen. So, after collection, the husband’s semen is processed in the laboratory to remove all those impurities and to select only the best number of healthy and movable sperms and it definitely increases success rates of IUI When IUI is generally advised? As you can understand, to perform IUI, there must be minimum number of sperms in the semen, the tubes must be opened, the ovaries must be releasing eggs. If these are present, IUI is usually advised ·Less than adequate number of sperm counts, morphology or motility ·Couples who cannot perform full penetrative intercourse but refuse or unable to conceive by IVI ·Unexplained infertility- although IVF is better than IUI, but considering the cost, many couples in our country opt for 2-3 cycles of IUI before IVF ·PCOS and Mild Endometriosis- where natural intercourse or ovulation induction failed ·Couples in whom only one partner is positive for HIV or Hepatitis B or C- where transmission from one partner to another by unprotected sexual intercourse is not preferable. What are the tests done before IUI? The basic infertility evaluation is done before IUI include husband’s semen analysis, assessment of ovarian function (blood tests, ultrasound) and uterus (ultrasound). In some cases, laparoscopy (putting camera to see inside the abdomen by operation) or hysteroscopy (putting camera through vagina inside the uterus, by operation) may be required. Now, if the tubes are blocked, IUI is of no use. So, testing the tubes is advisable before IUI. But some women, who are at low risk of tubal disease (no history of pelvic pain, infection or surgery), one or two cycles of IUI can be done, failing which tubes must be checked by tests like HSG or SSG or in some cases by laparoscopy. What IUI actually involves? In the cycle, in which IUI is planned, the woman is asked to take some medicines (or injections) in particular days of the periods as a part of “ovulation induction”. She is then advised to have ultrasound monitoring (TVS- transvaginal sonogram- where ultrasound probe is placed inside the vagina for better accuracy) to see if eggs are growing in response to the medicines or not. If eggs are growing, IUI is planned in a particular time when the egg (s) is more likely to rupture, so that the tie interval between sperm entry and egg release can be kept as minimum as possible. Is ovulation Induction necessary for IUI? Frankly speaking, IUI can be done without any medicines (as in case of natural intercourse or IVI), which is called “Natural Cycle IUI”, where only TVS monitoring is done to see how the eggs are growing. This may avoid some side effects of ovulation induction (see below) but is associated with low success rate than IUI done along with ovulation induction. Is TVS necessary before IUI? TVS is, undoubtedly, uncomfortable for the woman. But it gives better picture than ultrasound done conventionally. Now, the question is, whether ultrasound monitoring is at all needed or not. TVS directs the doctor how eggs are growing and at what number and size and when they are likely to rupture. Moreover, the rupture can also be confirmed by TVS. Again, the uncommon side effect of ovulation induction can be detected by TVS. That is called OHSS (“Ovarian Hyperstimulation Syndrome”) where excessive eggs can grow inside the ovaries and this can lead to collection of fluid inside abdomen and lungs and can turn very serious. Although very rare, it can be detected by TVS and early actions can be taken to prevent the progress of this condition. In rare cases, where TVS cannot be done or patient declines, only option is to check urine by LH kit to predict the likely timing of ovulation and at that time IUI is planned. However, it is less accurate than TVS monitoring and is associated with less success. What, if eggs are not growing in the ovaries? In some women, particularly those who are overweight, aged or some cases of PCOS, eggs may not respond initially to one medicine. There are various forms of ovulation induction medicines (tablets, injection). If one is not working, your doctor can try increasing the dose of that medicine or add or replace it with other medicines. Please remember, it’s difficult to predict what medicine will be best suited for a particular patient. So, it’s basically a trial and error process. What is done on the day of IUI? As timing is important, the couples are requested to stick to the timing, advised by the doctor. The husband will be asked to collect the semen by masturbation, using clean technique (to avoid contamination by germs in the semen container). The semen is then prepared by the embryologist and will be checked to see the final number of sperms and their motility and morphology. The wife is asked to lie down in the IUI table. After cleaning, a sterile speculum (instruments to separate walls of the vagina to see the cervix) is introduced inside the vagina and then 0.4-0.6 ml of the prepared semen is inserted inside the uterus with the help of a small catheter (fine tube). IUI done, under ultrasound guidance, gives better result than IUI done without it. The patient is asked to lie down few minutes after taking out the catheter and the speculum. The medicines are advised and then they can go home. Is IUI painful? Most women feel little discomfort during IUI but it should not be painful. If there is technical difficulty while putting catheter inside the uterus, your doctor will discuss it with you and in the next cycle, will plan management to solve this issue. What happens if husband cannot collect semen? Collection of semen in unfamiliar environment is understandably a matter of discomfort and seems awkward. Proper counseling and maintenance of privacy can help. Stress-free approach is needed. If it fails, do not hesitate to inform your doctor. Some medicines can help. But in those, who are unable to masturbate, there are some instruments, like ejaculator, can help to solve this problem. What happens if sperm count is low? IUI can be successful if sperm count is minimum more than 5 million per ml and there is reasonably good morphology and motility. If not, IVF or ICSI would be the better option. But IUI can serve as trial also. That means before putting the semen, the prepared sperms can be examined and it can be predicted what is the success rate of IUI in this particular case and whether IVF or ICSI would be needed. In rare occasions, where sperm count is extremely low but the couple do not wish for IVF or ICSI, pooled semen IUI can help- where the semen is collected in number of occasions and is preserved and the final pool is used for insemination, to give a reasonable success rate. When donor sperm is used and how? If a man does not have any sperms or too few sperms to do IUI, IVF or ICSI is not affordable, donor IUI is an alternative. But it is not done without consent from both husband and wife. The donor is not known to the couple or the doctor and no identity of the donor is revealed. No relative or friend can serve as donor. Donor semen is frozen semen, collected 6 months ago and the donor is tested for diseases like STD, HIV, Hepatitis B or C. Usual attempt is taken to chose donor having blood group and skin colour similar to those of the husband. But remember, it’s only given after discussion and written consent by the couple. Can a couple have intercourse in the cycle where IUI is advised? Intercourse around IUI increases the number of sperms available at the time of ovulation. When should one check for pregnancy? Usually if period does not come within 18 days after IUI, pregnancy test is advised. It can be done at home. If negative, then the cause of not having periods is sorted out. What is the chance of success after IUI? In one cycle, chance of success is around 20-25%. Most of the couples conceive after 3rd or 4th cycle of IUI. The chance of pregnancy after 6th cycle is low, so, usually IUI beyond 6 cycles is not advised. The factors where IUI gives better results include unexplained infertility, sexual dysfunction of any of the partner, PCOS and male subfertility (low sperm count or motility) What happens if IUI fails? As said earlier, you should think about further treatment, if 3rd or 4th cycle of IUI fails. There is no use of doing IUI beyond 6 cycles, unless natural intercourse is not possible and the age is favourable. IVF gives better result. Is there any harmful effect of IUI? Very few harmful effects have been noted, for examples, hazards of ovulation induction (OHSS< twin pregnancy), pain, infection and discomfort. As mentined, if raw semen is given, unusual allergic reaction can happen. How IUI is being done in your particular centre by Dr. Sujoy Dasgupta? We believe in patient’s autonomy. So we want to give time on discussion and presentation of facts and figures to the couples. We encourage questions from the couples and take utmost care so that no question remains unanswered. We do not take decisions and impose it on the couples. We advise the couples to take time before taking decision on a particular treatment. If the couple decides, we respect and support their decision. We try to take nominal charges and help couples to collect medicines (particularly injections) at lower prices than MRPs. After thorough evaluation of both the partners, we plan for ovulation induction drugs, with consent from them and advise them to come for TVS. After each day TVS, we explain the progress and probable timing of IUI. On the day of IUI, after requesting the couple to maintain punctuality, we advise the husband to collect semen, in comfortable atmosphere, maintaining the privacy. If there is problem in semen collection, we provide support to him and address his issues in sensitive way. Our expert trained embryologist then prepares the semen. We always encourage the couples to see the condition of raw and prepared semen under microscope to maintain the transparency. We advise the woman to fill up the bladder (to take water and not to urinate) to facilitate the passage of IUI catheter. Unlike other places, we perform IUI inside OT to prevent unwanted infection. Again we maintain our uniqueness in the sense that we perform it under ultrasound guidance. The ultrasound guidance has been scientifically proved to increase the success rate of IUI. Moreover, we show the woman in the ultrasound (real time) how the catheter has been put inside the uterus (to make sure that we are not doing IVI or have placed it in wrong position). This also helps to reduce patient’s anxiety and uncertainty. After that, our nurse takes care of the patient and observes her when she takes rest. Then we advise the post-IUI medicines and advise them what to expect and when they can go home. Again, this time we try to answer all questions the couples can ask. Conclusion Infertility is a peculiar thing. Very few men or women are absolutely infertile. That means they do not have ability to achieve pregnancy naturally. Majority of them are subfertile. That means most of them have lower than normal chance (compared to healthy couples) to achieve pregnancy in a normal menstrual cycle. Often we find that patients planning for treatment and in the mean time, they conceive naturally. That means even without treatment, there is some chance of pregnancy. Of course, it’s stressful situation for both the partners. Stress affects conjugal relationships and lead to many couples avoiding conjugal life. Indeed stress can affect the hormone levels in females and affects sexual performances in males. It’s easier for us to advise you to stay stress-free but is difficult to practice. Nevertheless, try relaxation as much as possible. Think that majority of the couples ultimately conceive by some form of treatment. Have faith in yourself and have faith in your doctor. 

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Dr. S.K. TandonM.D. Consultant Pathologist, CCEBDM Diabetes, PGDS Sexology USA, CCMTD Thyroid, ACDMC Heart Disease, CCMH Hypertension, ECGSexologist

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H1N1 influenza is sometimes called "swine flu" because it is usually found in pigs. You cannot become infected with H1N1 influenza from eating pork products. The injectable form of H1N1 influenza virus vaccine is a "killed virus" vaccine and will not cause you to become ill with the flu virus that it contains. View Slideshows Natural Cold & Flu Remedies Slideshow Anatomy of a Sore Throat Slideshow Flu Slideshow: 10 Foods to Eat When You Have the Flu Related Diseases Images & Quizzes Index Natural Cold & Flu Remedies Slideshow Anatomy of a Sore Throat Slideshow Flu Slideshow: 10 Foods to Eat When You Have the Flu Patient Comments: Swine Flu - Concerns and Risks Patient Comments: Swine Flu - Symptoms and Signs Patient Comments: Swine Flu - Treatment Swine flu (H1N1 and H3N2v influenza virus) facts What is the swine flu? How is swine flu transmitted? Is swine flu contagious? What is the incubation period for swine flu? What is the contagious period for swine flu? How long does the swine flu last? What causes swine flu? Why is swine flu now infecting humans? What are swine flu symptoms and signs? What tests do health care professionals use to diagnose swine flu? What types of health care professionals treat swine flu? What is the treatment for swine flu? What is the history of swine flu in humans? What are the risk factors for swine flu? Is it possible to prevent swine flu with a vaccine? Is it possible to prevent swine flu if the swine flu vaccine (or other flu strain vaccines) is not readily available? Are there home remedies for swine flu? Was swine flu (H1N1) a cause of an epidemic or pandemic in the 2009-2010 flu season? What is the prognosis (outlook) and complications for patients who get swine flu? Where can I find more information about swine flu (H1N1 and H3N2v)? Swine flu (H1N1 and H3N2v influenza virus) facts Swine flu is a respiratory disease caused by influenza viruses that infect the respiratory tract of pigs and result in a barking cough, decreased appetite, nasal secretions, and listless behavior; the virus can be transmitted to humans. Swine flu viruses may mutate (change) so that they are easily transmissible among humans. The April 2009 swine flu outbreak (pandemic) was due to infection with the H1N1 virus and was first observed in Mexico. Symptoms of swine flu in humans are similar to most influenza infections: fever (100 F or greater), cough, nasal secretions, fatigue, and headache. The incubation period for the disease is about one to four days. Swine flu is contagious about one day before symptoms develop to about five to seven days after symptoms develop; some patients may be contagious for a longer time span. The disease lasts about three to seven days with more serious infections lasting about nine to 10 days. Vaccination is the best way to prevent or reduce the chances of becoming infected with influenza viruses. Primary-care specialists, pediatricians, and emergency-medicine doctors usually treat the disease, but other specialists may be consulted if the flu is severe and/or complicated. Two antiviral agents, zanamivir (Relenza) and oseltamivir (Tamiflu), have been reported to help prevent or reduce the effects of swine flu if taken within 48 hours of the onset of symptoms. Some researchers disagree and suggest the antiviral agents have no effect. There are various methods listed in this article to help individuals from getting the flu. Home remedies are available, but patients should check with their doctors before use; over-the-counter medications may help reduce symptoms. The most serious complication of the flu is pneumonia. What is the swine flu? Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs, resulting in nasal secretions, a barking cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. And has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators decided the 2009 so-called "swine flu" strain, first seen in Mexico, should be termed novel H1N1 flu since it was mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type 1). The eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains. How is swine flu transmitted? Is swine flu contagious? Swine influenza is transmitted from person to person by inhalation or ingestion of droplets containing virus from people sneezing or coughing; it is not transmitted by eating cooked pork products. The newest swine flu virus that has caused swine flu is influenza A H3N2v (commonly termed H3N2v) that began as an outbreak in 2011. The "v" in the name means the virus is a variant that normally infects only pigs but has begun to infect humans. There have been small outbreaks of H1N1 influenza since the pandemic; a recent one is in India where at least three people have died. Quick Guide Common Respiratory Illnesses Common Respiratory Illnesses What to Do if You Think You Have H1N1 Swine Flu Virus If you've got fever, cough, or one of the other symptoms of the flu, you may be wondering if you have contracted the H1N1 swine flu virus. The reality is that it isn't possible to know unless specialized testing is ordered, and for uncomplicated cases of the flu in non-hospitalized patients, routine testing for the H1N1 virus is not being carried out. Learn when to seek medical care for H1N1 swine flu symptoms » What is the incubation period for swine flu? The incubation period for swine flu is about one to four days, with the average being two days; in some people, the incubation period may be as long as about seven days in adults and children. What is the contagious period for swine flu? The contagious period for swine influenza in adults usually begins one day before symptoms develop in an adult and it lasts about five to seven days after the person becomes sick. However, people with weakened immune systems and children may be contagious for a longer period of time (for example, about 10 to 14 days). How long does the swine flu last? In uncomplicated infections, swine flu typically begins to resolve after three to seven days, but the malaise and cough can persist two weeks or more in some patients. Severe swine flu may require hospitalization that increases the length of time of infection to about nine to 10 days. What causes swine flu? The cause of the 2009 swine flu was an influenza A virus type designated as H1N1. In 2011, a new swine flu virus was detected. The new strain was named influenza A (H3N2) v. Only a few people (mainly children) were first infected, but officials from the U.S. Centers for Disease Control and Prevention (CDC) reported increased numbers of people infected in the 2012-2013 flu season. Currently, there are not large numbers of people infected with H3N2v. Unfortunately, another virus termed H3N2 (note no "v" in its name) has been detected and caused flu, but this strain is different from H3N2v. In general, all of the influenza A viruses have a structure similar to the H1N1 virus; each type has a somewhat different H and/or N structure. Why is swine flu now infecting humans? Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans. First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA-segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (this process is known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a single cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes within an individual RNA segment in flu viruses are termed antigenic drift (see figure 1) and result in minor changes in the virus. However, these small genetic changes can accumulate over time to produce enough minor changes that cumulatively alter the virus' makeup over time (usually years). Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment, and this seems to be the major way that bird flu virus RNA segments enter the mammalian flu virus population. Figure 1 shows this process in H1N1, but the figure represents the genetic process for all flu viruses, including human, swine, and avian strains. Picture of antigenic shift and antigenic drift in swine flu (H1N1). Figure 1. What are swine flu symptoms and signs? Readers Comments 7 Share Your Story Symptoms of swine flu are similar to most influenza infections: fever (100 F or greater), cough (usually dry), nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients may also get a sore throat, rash, body (muscle) aches or pains, headaches, chills, nausea, vomiting, and diarrhea. In Mexico, many of the initial patients infected with H1N1 influenza were young adults, which made some investigators speculate that a strong immune response, as seen in young people, may cause some collateral tissue damage. The incubation period from exposure to first symptoms is about one to four days, with an average of two days. The symptoms last about one to two weeks and can last longer if the person has a severe infection. Some patients develop severe respiratory symptoms, such as shortness of breath, and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 "Spanish flu" epidemic had an estimated mortality rate ranging from 2%-20%. Swine (H1N1) flu in Mexico had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but these initial data were revised and the mortality rate worldwide was estimated to be much lower. Fortunately, the mortality rate of H1N1 remained low and similar to that of the conventional flu (average conventional flu mortality rate is about 36,000 per year; projected H1N1 flu mortality rate was 90,000 per year in the U.S. As determined by the president's advisory committee, but it never approached that high number). Fortunately, although H1N1 developed into a pandemic (worldwide) flu strain, the mortality rate in the U.S. And many other countries only approximated the usual numbers of flu deaths worldwide. Speculation about why the mortality rate remained much lower than predicted includes increased public awareness and action that produced an increase in hygiene (especially hand washing), a fairly rapid development of a new vaccine, and patient self-isolation if symptoms developed. What tests do health care professionals use to diagnose swine flu? Swine flu is presumptively diagnosed clinically by the patient's history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu. If it is positive for type A, the person could have a conventional flu strain or swine flu. However, the accuracy of these tests has been challenged, and the U.S. Centers for Disease Control and Prevention (CDC) has not completed their comparative studies of these tests. However, a new test developed by the CDC and a commercial company reportedly can detect H1N1 reliably in about one hour; the test was formerly only available to the military. In 2010, the FDA approved a commercially available test that could detect H1N1 within four hours. Most of these rapid tests are based on PCR technology. Swine flu is definitively diagnosed by identifying the particular antigens (surface proteins) associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors' offices or hospital laboratories. However, doctors' offices are able to send specimens to specialized laboratories if necessary. Because of the large number of novel H1N1 swine flu cases that occurred in the 2009-2010 flu season (the vast majority of flu cases [about 95%-99%] were due to novel H1N1 flu viruses), the CDC recommended only hospitalized patients' flu virus strains be sent to reference labs to be identified. H3N2v flu strains and other flu virus strains are diagnosed by similar methods. What types of health care professionals treat swine flu? Almost all uncomplicated patients with swine flu can be treated at home or by the patient's pediatrician, primary-care provider, or emergency-medicine doctor. For more complicated and/or severe swine flu infections, specialists such as critical-care specialists, lung specialists (pulmonologists), and infectious-disease specialists may be consulted. What is the treatment for swine flu? Readers Comments 1 Share Your Story The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has produced vaccines. The first H1N1 vaccine released in early October 2009 was a nasal spray vaccine that was approved for use in healthy individuals ages 2-49. The injectable vaccine, made from killed H1N1, became available in the second week of Oct. 2009. This vaccine was approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines were approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective. A new influenza vaccine preparation is the intradermal (trivalent) vaccine is available; it works like the shot except the administration is less painful. It is approved for ages 18-64 years. Almost all vaccines have some side effects. Common side effects of H1N1 vaccines (alone or in combination with other flu viral strains) are typical of flu vaccines used over many years and are as follows: Flu shot: Soreness, redness, minor swelling at the shot site, muscle aches, low-grade fever, and nausea do not usually last more than about 24 hours. Nasal spray: runny nose, low-grade fever, vomiting, headache, wheezing, cough, and sore throat Intradermal shot: redness, swelling, pain, headache, muscle aches, fatigue The flu shot (vaccine) is made from killed virus particles so a person cannot get the flu from a flu shot. However, the nasal spray vaccine contains live virus that have been altered to hinder its ability to replicate in human tissue. People with a suppressed immune system should not get vaccinated with the nasal spray. Also, most vaccines that contain flu viral particles are cultivated in eggs, so individuals with an allergy to eggs should not get the vaccine unless tested and advised by their doctor that they are cleared to obtain it. Like all vaccines, rare events may occur in some rare cases (for example, swelling, weakness, or shortness of breath). About one person in a million who gets the vaccine may develop a neurological problem termed Guillain-Barré syndrome, which can cause weakness or paralysis, difficulty breathing, bladder and/or bowel problems, and other nerve problems. If any symptoms like these develop, see a physician immediately. Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are zanamivir (Relenza) and oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their guidelines that pregnant females can be treated with the two antiviral agents. Some researchers suggest the data on Tamiflu and Relenza is not correct and suggest the antivirals are not effective. On Dec. 22, 2014, the FDA approved the first new anti-influenza drug (for H1N1 and other influenza virus types) in 15 years, peramivir injection (Rapivab). It is approved for use in the following settings: Diarrhea, skin infections, hallucinations, and/or altered behavior may occur as side effects of this drug. Adult patients for whom therapy with an intravenous (IV) medication is clinically appropriate, based upon one or more of the following reasons: The patient is not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV is not expected to be dependable or is not feasible, or the physician decides that IV therapy is appropriate due to other circumstances. Pediatric patients for whom an intravenous medication clinically appropriate because: The patient is not responding to either oral or inhaled antiviral therapy, or drug delivery by a route other than IV is not expected to be dependable or is not feasible. What is the history of swine flu in humans? In 1976, there was an outbreak of swine flu at Fort Dix. This virus was not the same as the 2009 H1N1 outbreak, but it was similar insofar as it was an influenza A virus that had similarities to the swine flu virus. There was one death at Fort Dix. The government decided to produce a vaccine against this virus, but the vaccine was associated with rare instances of neurological complications (Guillain-Barré syndrome) and was discontinued. Some individuals speculate that formalin, used to inactivate the virus, may have played a role in the development of this complication in 1976. One of the reasons it takes a few months to develop a new vaccine is to test the vaccine for safety to avoid the complications seen in the 1976 vaccine. Individuals with active infections or diseases of the nervous system are also not recommended to get flu vaccines. Early in the spring of 2009, H1N1 flu virus was first detected in Mexico, causing some deaths among a "younger" population. It began increasing during the summer 2009 and rapidly circulated to the U.S. And to Europe and eventually worldwide. The WHO declared it first fit their criteria for an epidemic and then, in June 2009, the WHO declared the first flu pandemic in 41 years. There was a worldwide concern and people began to improve in hand washing and other prevention methods while they awaited vaccine development. The trivalent vaccine made for the 2009-2010 flu season offered virtually no protection from H1N1. New vaccines were developed (both live and killed virus) and started to become available in Sept. 2009-Oct. 2009. The CDC established a protocol guideline for those who should get the vaccine first. By late December to January, a vaccine against H1N1 was available in moderate supply worldwide. The numbers of infected patients began to recede and the pandemic ended. However, a strain of H1N1 was incorporated into the yearly trivalent vaccine for the 2010-2011 flu season because the virus was present in the world populations. As stated in the first section of this article, a new strain of swine flu, (H3N2) v, was detected in 2011; it has not affected any large numbers of people in the current flu season. However, another antigenically distinct virus with the same H and N components (termed H3N2 (note no "v") has caused flu in humans; viral antigens were incorporated into the 2013-2014 seasonal flu shots and nasal spray vaccines. In India in 2015-2016, a large outbreak of swine flu has been ongoing; there are some researchers who claim the strain of virus has mutated slightly and has become able to cause more severe infections. What are the risk factors for swine flu? Readers Comments 32 Share Your Story Vaccination to prevent influenza is particularly important for people who are at increased risk for severe complications from influenza or at higher risk for influenza-related doctor or hospital visits. When vaccine supply is limited, vaccination efforts should focus on delivering vaccination to the following people since these populations have a higher risk for H1N1 and some other viral infections according to the CDC: All children 6 months to 4 years (59 months) of age All people 50 years of age and older Adults and children who have chronic pulmonary (including asthma) or cardiovascular (except isolated hypertension), renal, hepatic, neurological, hematologic, or metabolic disorders (including diabetes mellitus) People who have immunosuppression (including immunosuppression caused by medications or by HIV) Women who are or will be pregnant during the influenza season Children and adolescents (6 months to 18 years of age) who are receiving long-term aspirin therapy and who might be at risk for experiencing Reye's syndrome after influenza virus infection Residents of nursing homes and other long-term-care facilities American Indians/Alaska natives People who are morbidly obese (BMI ≥40) Health care professionals (doctors, nurses, health care personnel treating patients) Household contacts and caregivers of children under 5 years of age and adults 50 years of age and older, with particular emphasis on vaccinating contacts of children less than 6 months age Household contacts and caregivers of people with medical conditions that put them at higher risk for severe complications from influenza. The CDC recommends for the 2014-2015 flu season that everyone 6 months old and older should get a flu shot to prevent or reduce the chance of getting the flu. The best way to prevent novel H1N1 swine flu is vaccination. 

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Dr. Rajesh DeshwalMD - Internal Medicine, Fellowship in HIV MedicineHIV Specialist

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Dono test acche hain. Qualitative mein pata lagta hai ki HIV hai ki nahin aur Quantitative mein pata chalta hai ki KITNA hai. AAp negative hain aur nischint rahe. Best wishes. 

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Dr. Jagtap T NMBBSGeneral Physician

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Hiv combo test: It is now common for antibody tests to also test for antigens. These are called 4th generation tests or combined antibody/antigen (Ag/Ab) tests. In these tests the antigen being tested is a major HIV protein called p24. P24 (short for protein 24) is produced 2–3 weeks after infection and before antibodies are produced. A reactive result from a fourth generation HIV Ab/Ag combination assay means that HIV-1 p24 antigens, HIV-1 antibodies, and/or HIV-2 antibodies were detected in the sample processed. A secondary test is required to confirm the reactive result. P24 antigen is a viral protein that makes up most of the viral core. Serum concentrations of p24 antigen are high in the first few weeks after infection; tests sensitive to p24 antigen are therefore useful for diagnosing very early infection when antibody levels are still low. How long can p24 antigen be detected? The p24 antigen test can detect the p24 protein on average 10 to 14 days after infection with HIV. One drawback of this test is that levels of the p24 protein peak at around three to four weeks after exposure to HIV and are usually not detectable after five to six weeks (and sometimes even earlier). What is window period for p24 antigen test? The first HIV protein (antigen) that can be measured is p24 (from 1 to 8 weeks after exposure). Viral load and p24 tests are not accurate for diagnosing early HIV if the results are negative. An HIV antibody response can be detected as early as two weeks in a few people and in more than 99.9% of people by 12 weeks. The OraQuick ADVANCE® Rapid HIV-1/2 Antibody Test detects antibodies to HIV-1 and HIV-2 in 20 minutes. Rapid Provides results in 20 minutes, enabling patients to learn their status in a single visit and allows HIV positive patients to be connected to care immediately. Flexible Approved for oral fluid, plasma, fingerstick or venipuncture whole blood specimens. Ideal for both clinical and non-clinical settings. Accurate Greater than 99% agreement with confirmatory Western blot. 1 Simple CLIA-waived for oral fluid, fingerstick and venipuncture whole blood and offers the ability to test in non-traditional testing environments, such as outreach programs and mobile testing clinics. Patient-Preferred2 Offers patients accurate HIV testing without the need for blood or needles. Pain-free testing with oral fluid means more people get screened, more HIV positive patients are connected to care and fewer people are exposed. What does it mean to be CLIA waived? All facilities in the United States that perform laboratory testing on human specimens for health assessment or the diagnosis, prevention, or treatment of disease are regulated under the Clinical Laboratory Improvement Amendments of 1988 (CLIA. Mar 16, 2015. 

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Dr. Ishwar GiladaMBBS, DDV, FCPS, APEX, Diplomat American Board of SexologyHIV Specialist

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TDL has introduced a next generation HIV assay with the Bio-Rad BioPlex 2200 HIV Ag-Ab assay. This is the first commercial screening assay to be able to distinguish between HIV-1 antibodies, HIV-2 antibodies and HIV-1 p24 antigen in serum or plasma samples. In addition to the early detection offered by 4th generation assays, this 5th Generation assay provides more information by specifically identifying HIV-1 or HIV-2 and allows results of antigen and antibody detection to be reported individually. Because antigens and antibodies are detectable at different stages of the infection, reporting of both helps to differentiate between acute and established HIV infection. HIV-1 and HIV-2 are the two types of HIV, with HIV-1 being the most widespread worldwide. The two viruses are similar but distinct and different, which means that tests targeted to one type, will not detect the other. But there is no need of using this test. Even 4th Generation test is good enough, where window period is 15-17 days. Hence one can avoid PCR 

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