CD4 and infection: Because of social or economic reasons, PLHIV may not receive adequate care or be aware of the status of infection and institute treatment, and the diagnosis of AIDS may be delayed,[25,30] and cause a later initiation of ART at a low CD4 cell count (even <200 cells/mm3).[10] We also found that patients who started ART with WHO clinical stage 4 suffered from pulmonary TB or AIDS-related diseases, and patients who had symptoms 3 months before receiving ART services had a higher death hazard rate compared to those with WHO clinical stage 1 and were disease or symptom free.