BACKGROUND: Antiretroviral therapy (ART) has significantly improved outcomes for people living with HIV (PLWH), but poor CD4 METHODS: We conducted a comprehensive search of the EMBASE, PubMed, Web of Science, and Cochrane Library databases up to February 19, 2024, and included studies that reported the number of CEs along with the CD4 count at the time of the CEs or the most recent CD4 count prior to the CEs. A random-effects model was employed for meta-analysis to calculate odds ratios (ORs) and their 95% confidence intervals (CIs) for CEs at different CD4 count thresholds. FINDINGS: We included 15 studies with 54,766 PLWH and reported a significant inverse correlation between CD4 INTERPRETATION: This meta-analysis revealed an inverse relationship between CD4