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December 23, 1988

Lithium for Zidovudine-Induced Neutropenia in AIDS-Reply

Author Affiliations

University of Minnesota AIDS Clinical Trials Unit Minneapolis

University of Minnesota AIDS Clinical Trials Unit Minneapolis

JAMA. 1988;260(24):3588. doi:10.1001/jama.1988.03410240046018

In Reply.—  Herbert and colleagues suggest that lithium carbonate, because of its granulopoietic effect, might be used to treat zidovudine-induced neutropenia. Their intriguing postulate merits further study. In addition to the case described in this letter, Roberts et al1 published an uncontrolled study of five patients with zidovudine-associated neutropenia, four of whom appeared to respond to lithium. However, the relative contribution of reduction in the dose of zidovudine vs lithium therapy to the improved neutrophil counts can be objectively assessed only by a controlled trial, which Herbert et al tell us that they are conducting.We have three specific comments to the speculations raised in this letter. First, reducing the dose of zidovudine to subtherapeutic levels may be harmful because the patient's basic HIV disease then might progress unchecked. However, there is no evidence, as de Gans et al2 have noted, to substantiate the concept that increased HIV