The initiation of ART is best based on CD4 cell count, a marker of immune status, rather than on viral load, a marker of virologic replication. For patients with advanced symptoms, treatment should be started regardless of CD4 count. However, the point during the course of HIV infection at which antiretroviral therapy (ART) is best initiated in asymptomatic patients remains unclear. The objective of this study is to assess ART treatment outcomes verses CD4 count threshold among HIV/AIDS patients in Ras Desta hospital. This was a periodic retrospective cross sectional study of HIV positive patient's ART treatment outcomes in relation to CD4 count threshold in Ras Desta hospital. From all HIV positive patients who had registered for ART from September 2009-February 2011 at Ras Desta hospital, 636 patients had met the criteria of the study and they were selected. Out of the 636 patients chosen for the study, 372 (58.5 %) were females while 264 (41.5 %) were males. For the whole sample under study, the median age was 36 years. Out of 636 patients 504 patients had a CD4 count less than 200 cells /mm 3 , 120 had a CD4 count greater than 200 and less than 350 cells/µl. Lastly, a total of 12 patients had a CD4 count greater than 350 cells /mm 3 at the initiation of ART. Other findings show that for all patients in the study receiving ART, median weight was 53 Kg (range 27 kg to 93 kg). Four hundred eighty (75.5 %) patients were alive, twenty one (3.3 %) patients had transferred out, 67 (10.5 %) were lost to follow-up and 68 (10.7 %) had died during two year period of ART use. A further observations of the deaths revealed that 53 (78 %) were CD4 count less than 200 cells/µl, 14 (20.5 %) patients were CD4 count > 200 and < 350 cells/µl, while only 1 (1.5 %) of the patient were died whose CD4 count > 350 cells/µl. This study show that early initiation of ART at CD4 levels higher than 200 cells/µl reduces mortality, immune-depression and weight loss and also improve outcome of ART treatment in asymptomatic, ART-naive, HIV-infected people. Practitioners and policy-makers may consider initiating ART at levels > 200 cells/ µl.