There are three other cases in the literature of patients with reasonable HIV control on ART (CD4 > 200 cells/mL with negative HIV VL, n = 2; and CD4 > 500 with VL uncertain, n = 1) presenting with MDS that is clearly reported to be higher IPSS risk (see Table 1) [30, 32]. Here, CD4 is linked to myelodysplastic syndrome.