Lesotho has a high HIV prevalence of 22.7% among adults aged 15 years and older. Despite the introduction of a test and treatment strategy in 2016, severe immunodeficiency (CD4 count &amp;lt;200 cells/mm³) remains a challenge which predisposes people living with HIV to opportunistic infections, morbidity and mortality. The World Health Organization estimates that about 30–40% of people living with HIV starting ART in low- and middle-income settings have a CD4 cell count of fewer than 200 cells/mm3. We assessed the characteristics of people with severe immunodeficiency in Lesotho for programmatic interventions.