The finding from this study revealed that lower CD4 that is < 100 CD4cell/ul, long duration on first line ART, having history of lost to follow up, presence of base line opportunistic infection, base line nevirapine based NNRTI and start to take ART after 2 years of being confirmed HIV positive are independent predictors of first line ART treatment failure. Here, CD4 is linked to Opportunistic infection.