Our study does not support a major role of ART toxicity; although a small number of deaths were adjudicated as primarily drug-related (mainly to zidovudine [anemia/neutropenia/sepsis] and nevirapine [hepatic failure]), participants initiating ART with low CD4 counts suffered disproportionately from both drug- and HIV-related deaths, suggesting that advanced immunodeficiency at ART initiation, rather than ART alone, played a role in toxicity-related deaths [30]. This evidence concerns the gene CD4 and liver failure.