In addition to preserving lives and improving the quality of life of HIV infected individuals, the goal of ART is to achieve and maintain suppression of HIV replication to an undetectable level. This goal enables the treatment to remain effective in the long term since the emergence of resistant strains is limited by the low replication rate of HIV achieved under these conditions. The recovery of the immune system as determined through CD4 count monitoring is neither a very sensitive nor specific marker of virological suppression in individuals on ART. Therefore, monitoring the response to ART using just the WHO guidelines for RLS may lead to a significant delay in detecting the failure to achieve or maintain virological suppression among individuals who are failing treatment. This is in contrast to western settings where routine viral load testing leads to early detection of failure to achieve suppression.