CD4 and anemia: As the recovery of the CD4+ T-cell count is hindered by several patient and viral factors, including: residual viral replication, impaired thymic function, advanced age, enhanced T-cell activation and apoptosis, genetic variations, baseline anaemia and poor adherence [18, 21, 23, 24], our finding might not quest the efficacy of TDF based regimens in resource limited settings, even though it needs a further workup with adequately powered and methodological high quality study.