Further suppression of VL during the years 2009–2011 may have been due to two reasons: either, improved quality of treatment of co-infection or cardiometabolic disease in patients who had entered the program, that may have slowed viral progression (since inflammation and immune activation drives viral replication) [41]; [42], and/or, raising of the CD4 treatment threshold in 2010 from 200 to 350 cells/mL, hence removing the sickest patients from the untreated client pool. This evidence concerns the gene CD4 and coinfection.