In settings where CD4 count technology is not yet available, the patient’s total lymphocyte count may be used as a proxy for CD4 count as discussed above. However, measuring total lymphocyte count is a labor-intensive process and requires either expertise in microscopy or a cell counter; therefore, the most practical alternative to CD4 testing is clinical staging. The WHO recommends ART for all patients with Adult Clinical Stage III or IV disease, irrespective of total lymphocyte count, and for patients with Stage II disease when the total lymphocyte count is less than 1,200 cells/mm³.¹