Rupasinghe D, Kiertiburanakul S, Kamarulzaman A, et al. - Researchers sought for the factors that are linked with early mortality in people living with HIV (PLHIV) starting antiretroviral therapy (ART) at low CD4 levels in the Asia-Pacific. They assessed 1813 PLHIV (74% male) who were enrolled in Therapeutics, Research, Education and AIDS Training in Asia (TREAT Asia) HIV Observational Database (TAHOD) and had initiated ART with a CD4 count < 100 cells/μL between 2003 and 2018. They identified reporting of 73 (4%) deaths indicating the overall first-year mortality rate of 4.27 per 100 person-years. AIDS-related deaths were reported in 38 (52%), immune reconstituted inflammatory syndrome (IRIS)-related in 10 (14%), non-AIDS-related in 13 (18%) and unknown cause of death was reported in 12 (16%). Risk factors were a BMI < 18.5 compared with BMI 18.5–24.9, and alanine aminotransferase (ALT) ≥ 5 times its upper limit of normal (ULN) compared with ALT < 5 times its ULN. Reduced hazard for mortality was noted in correlation to a higher CD4 count (51–100 cells/μL: SHR 0.28; 95% CI 0.14–0.55; and > 100 cells/μL: SHR 0.12; 95% CI 0.05–0.26) compared with CD4 count ≤ 25 cells/μL. Improved short-term survival rates could be achieved with efforts to initiate ART at CD4 counts > 50 cell/μL, even in those with late stages of HIV disease.