CD4 and Opportunistic infection: Accordingly, the this study findings revealed that base line opportunistic infection, staying on first line ART for greater than 5 years, starting ART after 2 month of being confirmed HIV positive, Initiate base line ART with NVP based NNRTI, having history of lost to follow up and having base line CD4 less than 100cell/mm3 were identified to be significantly associated with first line ART treatment failure.