Clinical-Immunological and Psychopathological Manifestations in HIV/AIDS Patients

and neurological manifestations besides serious psychological alterations with social repercussion. Method: A descriptive and transversal, correlative with a quantitative approach that compliments with a data qualitative analysis (paradigm convergence) was carried out in 45 patients diagnosed with HIV/AIDS in Santiago de Cuba Municipality, assisted at “Dr. Juan Bruno Zayas Alfonso” General University Hospital from January 2017 to January 2019. Objective: To characterize clinical-immunological and psychopathological aspects in HIV/AIDS patients. Results: There is a marked relationship among opportunistic diseases such as oropharyngeal candidiasis (25 patients) 73,5% and anxiety as a state. The evolution case AIDS is accelerated between 1 and 4 years representing a period in which the patients make their debut as an AIDS case and depression constitute a significant process in the deterioration of AIDS patients with media and high percentage levels. Conclusion: AIDS is still a health problem in our territory, being demonstrated the relationship between organic physio pathologic and psychological alterations and this health-disease process.

over the world. Until November 2011 there were a total of 4689 seropositive alive and 6238 people living with HIV/AIDS. There is a prevalence of male sex with a total of 6238, followed by men that have sex with other men (HSH) which add up 5376 [4]. AIDS has never been known before in the history of humanity. It has been affecting us since the second half of last century, acquiring a new pandemic dimension [4].
Not few patients affected with this serious flagellum behave aggressively and occasionally have inappropriate human behavior to society. Multiple researches carried out in the last decade from the health psychology perspective have contributed to the management of this phenomenon of great social and human repercussion, since they have made approximation to study the role of emotional states in the course of this disease. At present there are scientific evidence that allow to suppose that positive emotions potentiate health, while negative tend to diminish it. It has been discovered that negative emotions such as anger, anxiety or depression weaken the effectiveness of certain immunological cells, making that the contaminated patients with the virus become more susceptible of contracting opportunist diseases [5][6][7]. In this province (Santiago de Cuba) AIDS has been perceived as a serious health problem in the sanitary order, where the illness has had diverse clinical presentations and one of them has been directly related with dysfunctions in the psychological sphere that greatly threatens this group of patients. According to experts in this thematic the study of this phenomenon is reduced in Santiago de Cuba. Some research related with this problem report that there is a tendency to increment after Havana city [1,[5][6][7][8]. In this sense, it becomes necessary to carry out a research that values the main repercussions in the clinical and psychological affections in patients with HIV/AIDS. For this reason, a research was carried out with the objective of characterizing the physio-pathological and psychological aspects in this group of patients. Based on the abovementioned it was planned to give an answer to the following question: Do the percentage magnitude of the clinical and psychological evolution of AIDS patients overcome 90% of that reflected in the national and international literature?

Method
A descriptive and transversal, correlative with a quantitative approach that is supplemented with a qualitative analysis of the data (paradigm convergence) was carried out. Clinical and psychological variables were selected according to the national strategic program for the prevention and control of STD and HIV/AIDS [9], the stock list anxiety state-feature of Spielberger [10] and Beck depression stock list to respectively measure depression. Anonymity of the sick persons was guaranteed, with a view of protecting the privacy of the participants.

Discussion
AIDS is a sanitary problem of great magnitude which affects the world. People with this morbid condition not only the physiological function is affected but also the emotional and mental state; they are faced to a series of sociocultural, economic and psychological stressors with which they should fight [6][7][8]. This research coincides with this aspect because it showed the association among the physiological alterations that lead to illnesses such as neurotoxoplasmosis and anxiety, a psychological factor broadly studied. Several paper works, according with the above mention, point out that the life expectancy of infected fellows has increased considerably and that the infection has turned to be a chronic treatable disease, whose attention transcend the biological dominium, taking a greater importance for the comprehensive patients management and the improvement of their life quality and that of their relatives, aspects such as stigmatization, discrimination, inequality between sexes, social relationship, mental health, economic independence, environmental security among other which constitute great needs in some contexts and barriers in other, [1,6,9] which contribute to the development of psychological aspects such as anxiety, depression, anger and of course to the development of opportunist infections [6,8]. Life quality, a deeper aspect, intervene in these complex qualitative phenomena that these patients have to face once diagnosed [12][13][14][15].
It seems to be that in the last years between 1 and 4 years has been dominating the outcome moment of opportunistic diseases, and also the moment in which there is most immunological debacle in these patients, [10] phenomenon not very well studied in relation to the psychological factor's association. This is the predominant identified the presence of anger, irritability, concern, negativity, fear, somatic reactions, trouble sleeping and negative emotional states which could be interpreted as acute stress [18][19][20]. Other studies carried out [11,14] refer that stress accompanied by a bad life quality obstruct the immunologic system regulation, with the consequence decrease of the organism defense of these patients and so a greater acceleration from the initial diagnosis until the outcome of the diagnosis as AIDS patients, a Physio pathological factor that forces the setting up of anti-retroviral medications.
Other serious researches highlight the psychologists work who tried to minimize the risk factors and to improve the patient's life quality, related with anxiety, anger as psychological components [18][19][20]. Symptoms of anxiety and depression have been more frequently reported [17,18]. This last one has been described as one of the main problems comorbid to infection for HIV (between 2 and 4 times more than in the general population) with a prevalence between 29 and 79% [17].
It has been identified that in Colombia, high levels of anxiety and depression in these patients, which negatively correlate with the control perception [19]. Also, their association has been reported with the type of confrontation strategies that the fellows use [17].  what has been notified in other investigations [18,19].
This dysfunction in the emotional acting is a sign of alert for the repercussion on the illness evolution proper, mediated by the effect in the immunological system, this is an aspect according to experts' criteria from Santiago province, frequently undervalued by the physician who does the patients follow up. It was found, in a Colombian study [18], a high prevalence of people with the diagnosis of HIV who presented depression as comorbidity without being detected by their family physician and this had an impact in the development and illness care with less adherence in the treatment or medical recommendations. Researchers affirm that an adequate psychological and social support manifest lower levels of depression which helps to improve the somatic people´s health [19,20]. Our investigation possesses similar approaches to those previously mentioned and at most of the work that doctors and nurses should carry out, a colloquial importance should be given to this symptomatology. Depression and anxiety produce changes in the clinical parameters, and they directly rebound mainly in the individual health in men that suffer HIV/AIDS, but not necessarily for the diagnosis in itself, but for the social and individual problems that often surround this group of patients [20]. The patient, logically sick, is a scientific problem for our modern professionals; if we want to be exact or the nearest to this individualized opinion, it constitutes an inevitable necessity to solidify the theoretical and physio pathological bases of the illnesses that allow them to undertake the roads, not simple, but, with zeal, passable, for the construction of knowledge [20].
AIDS will continue as a devastating illness and just with qualified personnel we will be able to approach the mere form of its confrontation. It is concluded then that, AIDS continues being a problem of health in our territory, where there is a correlation in a high magnitude between opportunists' illnesses with the psychological problems as anxiety as a state, finding that the evolution to case AIDS has narrow relationship with the phenomena of stress and depression, clinically evidenced by the values of CD4 and less marked with the viral load. The estimate in relation to depression suggests that it is marked in this sick studied population, leading to clinical complications that can be lethal if not treated with opportunity.