Dube Tanyaradzwa Nicolette, Mboniswa Fezeka, Qwana Samkelisiwe Ethel, Charalambous Salome, Ndlovu Nontobeko, Grant Alison D, Hanifa Yasmeen, Machinya Johannes
The Aurum Institute, Johannesburg, South Africa.
Research Consulting Specialists CC, Johannesburg, South Africa.
PLoS One. 2025 Sep 22;20(9):e0331904. doi: 10.1371/journal.pone.0331904. eCollection 2025.
HIV weakens the immune system, increasing the risk of tuberculosis (TB) in people with living HIV (PLHIV). People living with HIV and on antiretroviral treatment (ART) often experience physical body size changes. Studies have found a significant discrepancy between PLHIV's self-reported weight loss and their measured weight loss when being screened for TB using the WHO tool. To understand this inconsistency, a qualitative sub-study was conducted to explore perceptions and attitudes towards weight change among adults attending HIV care, as well as health care workers in public clinics in Gauteng, South Africa.
Our qualitative study was nested within the XPHACTOR study. A total of seven focus group discussions were conducted, five with adult participants attending for HIV care and two with health care workers and research staff in clinics around Gauteng. Inductive thematic analysis was used to analyse the data.
The majority of PLHIV preferred to gain weight due to fear of stigma associated with weight loss. Weight loss is associated with HIV/AIDS, suggesting that people attending HIV care may underreport weight loss in the context of a TB symptoms screening tool because they fear stigma. Participants reported that weight changes impacted their daily lives and had psychological effects on them. Some PLHIV described lipodystrophy as disproportional weight gain. Culture and media have an influence on the perception of ideal body size and shape for both men and women.
Underreporting weight loss might result in poor sensitivity of the WHO TB screening tool and suggests that we need either alternative ways to determine weight loss or screening tools for TB that are less dependent on reported symptoms.
艾滋病毒会削弱免疫系统，增加艾滋病毒感染者（PLHIV）患结核病（TB）的风险。接受抗逆转录病毒治疗（ART）的艾滋病毒感染者经常会出现身体尺寸变化。研究发现，在使用世界卫生组织工具进行结核病筛查时，艾滋病毒感染者自我报告的体重减轻与测量的体重减轻之间存在显著差异。为了理解这种不一致性，开展了一项定性子研究，以探讨南非豪登省参加艾滋病毒护理的成年人以及公共诊所医护人员对体重变化的看法和态度。
我们的定性研究嵌套在XPHACTOR研究中。总共进行了七次焦点小组讨论，五次是与参加艾滋病毒护理的成年参与者进行的，两次是与豪登省各地诊所的医护人员和研究人员进行的。采用归纳主题分析法对数据进行分析。
大多数艾滋病毒感染者因担心与体重减轻相关的耻辱感而希望增加体重。体重减轻与艾滋病毒/艾滋病有关，这表明在结核病症状筛查工具的背景下，参加艾滋病毒护理的人可能会少报体重减轻情况，因为他们害怕耻辱感。参与者报告说，体重变化影响了他们的日常生活，并对他们产生了心理影响。一些艾滋病毒感染者将脂肪代谢障碍描述为不成比例的体重增加。文化和媒体对男性和女性理想体型和身材的认知都有影响。
少报体重减轻情况可能会导致世界卫生组织结核病筛查工具的敏感性不佳，这表明我们需要要么采用其他方法来确定体重减轻情况，要么采用较少依赖报告症状的结核病筛查工具。
