CD4 and mitochondrial DNA depletion syndrome 4a: Although ART should be initiated among everyone living with HIV at any CD4 cell count [8], individuals presenting with AHD may have a lower efficacy of ART and increase the risk of HIV transmission due to a lack of awareness of serostatus [6, 7], which is detrimental to 90‐90‐90 targets and ending AIDS by 2030.