CHAPTER 1

The Problem and Its Background

Introduction

Human Immunodeficiency Virus (HIV) which can cause Acquired

Immunodeficiency Syndrome (AIDS) not only represents the most severe epidemic in

contemporary times, but also the greatest public health challenge in history. The

collective effort of the scientific community has turned this inevitably lethal disease into

a manageable although not yet curable chronic condition. The improvement of

antiretroviral treatment is not just a history of scientific progress: it is the outcome of the

fervent 'union' towards a shared objective between pharmaceutical industries, nurses and

doctors, researchers, public health officials and the community of people living positively

(PLHIV). In addition, the rapid and cumulative advancement of antiretroviral therapy has

not just demonstrated to be lifesaving for many but has been contributory in exposing

injustice as well when it comes to access between rich and poor countries.

According to a study by Palmisano and Vella on history of antiretroviral therapy,

after the identification of HIV in 1981 as a novel distinct immunodeficiency syndrome

(“acquired” rather than “primary”), characterized by a depletion of CD4+ T cells and an

expansion of activated CD8+T cells, in 1983 AIDS was finally associated to HIV in a

causative way. Following the development of a diagnostic tool, a huge mass of

information on the epidemiology of the disease were rapidly collected. Thanks to huge

efforts and resources employment worldwide, most aspects of HIV biology and disease

pathogenesis were clarified, allowing pharmacological research to develop, as of today,

23 antiretroviral agents with different mechanisms of action, that can be variously

combined.

In present, HIV is treated with antiretroviral medications, which work by stopping

the virus replicating in the body. This allows the immune system to repair itself and avoid

further damage. Since HIV can quickly adapt and become resistant, with the use of

Antiretroviral Therapy that is consist of a combination of HIV medications it aims to

suppress the virus, stops the progression, and also prevents onward transmission of HIV

disease. Antiretroviral Therapy is highly recommended by the World Health

Organization (WHO) for all people who are diagnosed with HIV when their CD4 count

reaches or is below 350 cells/mm3. However, Antiretroviral treatments should

immediately start for those patients experiencing HIV related illness regardless of their

CD4 counts.

Lastly, it is a common knowledge that patients who have HIV and other diseases

acquired from sexual transmissions faces a great battle not only on what they are

experiencing but also on how people see and have misconceptions on their case.

According to the study conducted by Arboleda and Florenz it was shown that stigma

arises from lack of awareness, education and understanding. The lack of information and

understanding generates fear from people getting HIV that further leads on HIV patients

to develop negative self-image. In addition, because of this HIV discrimination and

stigma being thrown to people with this kind of disease appears as a contributory factor

on emotional and mental health stress and damages. However, with the aid of medical

allies especially personnel in the field of pharmacy who have an in-depth knowledge

regarding the different risk factors and modes of Human Immunodeficiency Virus (HIV)
would give opportunities to provide and correct misconceptions and help others to learn

more about HIV.

Conceptual Framework

The conceptual framework of this study is depicted in the paradigm given below

shown in Figure 1. The paradigm used is the IPO model. The system approach (Input-

Process-Output) was used in describing the conceptual framework of the study. This will

serve as a reference structure for the discussion of the literature, methodology, and

results.

Figure 1. The Input-Process-Output (IPO) Model shows the conceptual model to

guide this study in the research process.

In the Input block, the problem stated in chapter one and the respondents of the

study which are fourth year pharmacy students at University of Sto. Thomas are disclosed

as well as the different related studies.

In the Process block, includes data gathering methods and how the researchers

will interpret and handle the data collected.

The output block consists of the previous results of the study which served as

basis for the researchers and a key to further investigate and strengthen the possible

outcome of their study.

 PROCESS
- Questionnaire among
Pharmacy students OUTPUT
INPUT from the University of To determine how
- Respondents' Sto. Thomas well does the fourth-
profile - Analysis and year pharmacy
Interpretation of data students are
- Statement of the
knowledgeable and
problem - Test for any informed about how
- Different Related significant differences antiretroviral therapy
Studies in the efficacy of the works in HIV
variable patients
- Statistical treatment
of data

Figure 1: Conceptual Framework of the Study

Statement of the Problem

The main concern of this research is to know how well the fourth-year pharmacy

students does are knowledgeable and informed about how antiretroviral therapy works in

HIV patients.

Specifically, this research aims to answer the following questions:

1. What is Antiretroviral Therapy (ART)?

2. How effective this therapy works on patients with HIV? What are the different

adverse effects concerning the said therapy?

3. How well is the participants knowledge on the different preventive acts regarding

HIV?
Hypothesis

If most of the respondents were able to relate and familiarize with antiretroviral

therapy, then the fourth-year pharmacy students are most likely knowledgeable and

informed about how antiretroviral therapy works in HIV patients.

Significance of the Study

This study would be a significant endeavor in understanding how antiretroviral

therapy works in HIV patients specially for the fourth-year pharmacy students. This study

will also be beneficial to the public to understand and have knowledge towards

antiretroviral therapy. This could be very useful to the following:

Students. The study would give the students additional knowledge and

understanding as well as an overall and expounded overview of antiretroviral therapy and

from this would be part as an essential role in practicing pharmacy.

HIV Patients. Through this study, it will help make their children eat vegetables

as this will serve as a new meal option that is very healthy and nutritious without

sacrificing the taste and cost.

Medical Personnel. Antiretroviral therapy knowledge in HIV patients would give

a different perspective and overview in treating HIV patients. Safety measures and

precautions would be dealt carefully and would likely give a positive approach in the

treatment process of HIV patients.

 General Public . The study will give them insights towards understanding the HIV

patients, their welfare, feelings, and the needed affection in dealing with them. It would

also give a different overview and approach to HIV patients.

Other Researchers. This study can be used to guide and give necessary knowledge

and information to graduate students/researchers for continuous information regarding

the antiretroviral therapy for HIV patients.

Scope and Limitation of the Study

The research primarily focuses on the knowledge of fourth-year pharmacy

students about how antiretroviral therapy works in HIV patients.

The researchers were tasked to conduct a research survey among the fourth-year

students of pharmacy and evaluate each and everyone’s knowledge towards the

antiretroviral therapy.

The test was limited towards fellow higher years of pharmacy students from

University of Santo Tomas (UST) in order to gain different opinions that could either

give their personal insights, state specific strengths and weaknesses in knowledge and

understanding on the antiretroviral therapy works in HIV patients.

Definition of Terms

AIDS (Acquired Immunodeficiency Syndrome). A chronic, potentially life-

threatening condition caused by the human immunodeficiency virus (HIV)

Antiretroviral therapy. An effective treatment for HIV. It does not cure the

condition, but it can reduce the viral load to undetectable levels.

 CD4+ T cells. T-cells are a subset of white blood cells that play an important role

in the body's immune system. CD4 is, by contrast, a type of protein found on the certain

immune cells like T-cells, macrophages, and monocytes.

CD8+ T cells. Cytotoxic T cells, like CD4+ Helper T cells, are generated in the

thymus and express the T-cell receptor. However, rather than the CD4 molecule,

cytotoxic T cells express a dimeric co-receptor, CD8, usually composed of one CD8α and

one CD8β chain. CD8+ T cells recognise peptides presented by MHC Class I molecules,

found on all nucleated cells.

Chronic. Continuing or occurring again and again for a long time.

Epidemic. Affecting or tending to affect a disproportionately large number of

individuals within a population, community, or region at the same time.

Epidemiology. The branch of medicine which deals with the incidence,

distribution, and possible control of diseases and other factors relating to health.

HIV (Human Immunodeficiency Virus). HIV is a sexually transmitted infection

(STI). It can also be spread by contact with infected blood or from mother to child during

pregnancy, childbirth, or breast-feeding. Without medication, it may take years before

HIV weakens your immune system to the point that you have AIDS.

Lethal Diseases. Lethal mean causing or capable of causing death. deadly applies

to an established or very likely cause of death. a deadly disease mortal implies that death

has occurred or is inevitable.

 Mechanism of action. In pharmacology, the term mechanism of action refers to

the specific biochemical interaction through which a drug substance produces its

pharmacological effect. A mechanism of action usually includes mention of the specific

molecular targets to which the drug binds, such as an enzyme or receptor.

Pathogenesis. The origination and development of a disease.