{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:28:06Z","timestamp":1787027286726,"version":"build-2736575974"},"reference-count":42,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T00:00:00Z","timestamp":1772582400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      For people living with HIV (PLWH), CD4 count serves as an effective indicator of response to antiretroviral therapy (ART) and a predictor of morbidity and mortality before and after ART initiation. In PLWH on ART, changes in CD4 count reflect immunological response to treatment. CD4 count recovery after ART initiation is defined as achieving a CD4 cell count of \u2265500 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      . 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and methods<\/jats:title>\n                    <jats:p>\n                      Secondary data were collected by CAPRISA from June 2004 to August 2013, with monthly hospital visits. Time to CD4 recovery was calculated from ART initiation to the first CD4 count \u2265500 cells\/mm\n                      <jats:sup>3<\/jats:sup>\n                      . Participants were followed until recovery; those who did not recover, were lost to follow-up, or died were censored. Kaplan\u2013Meier curves estimated median survival time, while Cox and Weibull regression models identified risk factors associated with CD4 recovery.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 2,528 participants (median age 32\u202fyears), 1,803 had viral load &amp;lt;400 copies\/mL, 1,589 were females, and 524 had TB. By the end of the study, 727 achieved CD4 recovery. Kaplan\u2013Meier estimates showed median time to recovery of nearly 40\u202fmonths for females and 59\u202fmonths for males. The Weibull model outperformed the Cox model. Male participants had a 41% lower hazard of recovery than females [HR: 0.589, 95% CI: 0.497\u20130.698], while rural care was associated with a 49% higher hazard of recovery than urban settings [HR: 1.494, 95% CI: 1.228\u20131.818]. TB-coinfected participants had a 39.5% lower hazard [HR: 0.605, 95% CI: 0.489\u20130.748], whereas those with viral suppression had a 49% higher hazard of recovery [HR: 1.489, 95% CI: 1.213\u20131.826].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Delayed CD4 recovery among males, urban residents, TB-coinfected participants, and those with unsuppressed viral load (&amp;gt;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\u2013HIV integrated services, intensified adherence and viral load monitoring, and context-specific interventions in urban settings to accelerate immunological recovery and reduce HIV-related morbidity.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fpubh.2026.1766369","type":"journal-article","created":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T07:03:51Z","timestamp":1772607831000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Determinants of CD4 count recovery among severely immunosuppressed HIV patients initiated on antiretroviral therapy: a prospective cohort study in KwaZulu-Natal, South Africa"],"prefix":"10.3389","volume":"14","author":[{"given":"Chiedza Elvina","family":"Mashiri","sequence":"first","affiliation":[{"name":"Department of Applied Mathematics and Statistics, Midlands State 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