Determinants of CD4 count recovery among severely immunosuppressed HIV patients initiated on antiretroviral therapy: a prospective cohort study in KwaZulu-Natal, South Africa

Background: . This study utilised survival analysis techniques to determine time to CD4 count recovery and to identify determinants among PLWH with severe immunosuppression who were initiated on ART in KwaZulu-Natal, South Africa. Materials and methods: . Participants were followed until recovery; those who did not recover, were lost to follow-up, or died were censored. Kaplan-Meier curves estimated median survival time, while Cox and Weibull regression models identified risk factors associated with CD4 recovery. Results: Among 2,528 participants (median age 32 years), 1,803 had viral load 400 copies/mL) underscores the need for targeted, differentiated HIV care strategies to accelerate immunological recovery and reduce HIV-related morbidity. Policymakers should prioritise male-focused interventions, strengthened TB-HIV integrated services, intensified adherence and viral load monitoring, and context-specific interventions in urban settings to accelerate immunological recovery and reduce HIV-related morbidity.