CASE 3

• 54 yr-old man• HIV +• Asymptomatic• TDF/FTC/Efavirenz• CD4 510 HIV viral load <40

CASE 3

• Hb found to be low but stable at 120 g/l over last 6 months…normocytic

• Workup for all the usual causes negative except that low testosterone identified…Hb normalized with testosterone therapy

CASE 3

Serum Immunoelectrophoresis

IGG IGA IGM

Monoclonal spike accounting for 25% of IgG..no suppression of other Igs

31.3 2.81 2.44

What would you do?

CASE 3

Serum ImmunoelectrophoresIs

IGG IGA IGM

IgG 25% monoclonal spike

31.3 2.81 2.44

IgG 20% monoclonal spike

28.4 2.89 2.19

IgG 15% monoclonal spike

24.1 2.24 2.11

Follow-up over 1 year