Fatti G, Grimwood A, Nachega JB, et al. - In view of the concerns regarding decreased adherence and HIV virological suppression (VS) among clinically well people initiating antiretroviral therapy (ART) with raised pre-ART CD4 cell counts, researchers here compared virological outcomes by pre-ART CD4 count, where universal ART initiation was performed in the HIV Prevention Trials Network 071 (PopART) trial in South Africa prior to routine national and international implementation. Adults (n = 1901) initiating ART at facilities providing universal ART since January 2014 were assessed for VS (< 400 copies/mL), confirmed virological failure (VF) (2 consecutive viral loads > 1000 copies/mL), and viral rebound. Participants with baseline CD4 count of ≥ 500 cells/µL had VS of ≥ 94% at all 6-month intervals to 30 months. Participants with baseline CD4 count ≥ 500 cells/µL (3.3%), vs those with CD4 count 200–499 cells/µL (9.2%), independently exhibited lower risk of an elevated viral load (≥ 400 copies/mL) between months 18 and 30. Participants with baseline CD4 count ≥ 500 cells/µL independently exhibited lower VF and those with baseline CD4 count < 200 cells/µL exhibited 3-fold higher VF. These findings suggest that participants initiating ART with CD4 counts ≥ 500 cells/µL exhibit very good virological outcomes, despite previous concerns; the outcomes were better than those observed in participants with CD4 counts 200–499 cells/µL.