CD4 and Opportunistic infection: Based on our experience as healthcare providers in Africa and a review of the literature we identified 5 health systems failures which may cause preventable in-hospital mortality, including late presentation of HIV cases, low rates of in-hospital HIV testing, poor laboratory capacity which limits CD4 T-cell testing and the diagnosis of opportunistic infections, delay in initiation of ART in-hospital, and lastly, problems associated with loss to follow-up upon discharge from hospital.