We are concerned about this finding because co-infection with TB and hepatitis B in YLHIV can significantly affect the progression to AHD and the development of comorbidities such as immune reconstitution disease and hepatocellular carcinoma (39,40) Furthermore, a recent study (24) in Sierra Leone showed a high prevalence of stroke in HIV patients with lower CD4 cell counts. Here, CD4 is linked to mitochondrial DNA depletion syndrome 4a.