CD4 and Opportunistic infection: There are mixed results in patients with CD4 < 200 cells/mm3 and subsequent viral suppression as a systematic review by Lailulo et al. [29] done to identify factors associated with ART treatment failure showed that the likelihood of treatment failure was significantly higher in patients with CD4 < 200 cells/mm3 (OR, 4.82; 95% CI 2.44–9.52) in resource limited areas perhaps due to HIV related opportunistic infections, increased pill burdens and the potential to develop increased drug toxicity in patients with advanced disease on multiple medications [29].