CD4 and immune system disorder: Because the participants in this study had advanced disease (median CD4 at ART initiation 98 cells/μL) and malnutrition, our findings may not be generalizable to the larger population of HIV-infected adults initiating ART in sub-Saharan Africa, although it is worth noting that the mean CD4 count at ART initiation in sub-Saharan African programs in 2002 was 152 cells/μL and has not increased significantly since then, meaning that many patients still start ART in the setting of advanced immunodeficiency [34].