BACKGROUND: There are different recommendations on how to initiate Anti retroviral therapy (ART). Most of these recommendations require evidence of immunological deterioration for one to start ART. In Malawi, initiating ART is usually based on a positive HIV test and clinical staging using a W.H.O staging system. RATIONALE: There is limited data locally or internationally that has looked at the validity of using WHO staging as the sole entry point to an ART program and also limited data in using only clinical parameters to determine good response of its ART recipients. METHODS: A retrospective descriptive audit of 230 HIV positive patients’ records that had completed one year of ART at the Rainbow clinic in Mzuzu Central Hospital. RESULTS: At the start of ART, 29 patients were in WHO stages 1 and 2, 154 were in stage 3 and 47 in stage 4. CD4 count range for all stages was 1- 1062 cells/mm3. Initial mean CD4 counts were 152, 188, and 140 for WHO stages 1 &2, 3 and 4 respectively and initial mean BMI values were 21, 19 and 20 for WHO stages 1&2, 3 and 4 respectively. Patients in all WHO stages showed some significant increase in both CD4 cell counts and BMI over the 4 monthly follow up to 12 months p value less than 0.05. CONCLUSION: A patient’s WHO stage at the start of ART does not seem to reflect the severity of immune-depression