Additionally, as in other low-income settings, limited access todiagnostic facilities may explain the low detection of opportunistic infections,supporting the need for availability of accurate diagnostic tests in these settings [45, 46].Therewas an increasing trend of the median CD4+ cell counts in women without AHD duringthe 36 months follow-up, however, this remained constantly below 200 cells/mm3in women with AHD at first ANC visit. Here, CD4 is linked to mitochondrial DNA depletion syndrome 4a.