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To the Editor: Dr Steinberg and colleagues¹ did not find any increase in opportunistic infections in patients with SCA who received hydroxyurea therapy. Indeed, the risk of such infections is apparently low.²

We recently reported a case of a patient who developed a chronic opportunistic infection associated with hydroxyurea therapy.³ This was associated with abnormalities in T-lymphocytes, including a low CD4 cell count and low CD4:CD8 ratio. Both the infection and these abnormalities resolved after discontinuation of hydroxyurea. We believe that this observation is consistent with the possibility that this drug, like other antimetabolites, may suppress T-lymphocyte counts. While Steinberg et al did monitor neutrophil, red blood cell, and platelet counts, they did not examine lymphocyte parameters. We believe that future studies involving the use of this drug, especially in patients with less-severe SCA, should include a formal assessment of its affect on lymphocyte counts.

Lawrence Feldman, MD; Sandra Allen; Maxwell Westerman, MD
Department of Medicine
Mount Sinai Hospital Medical Center
Chicago, Ill

Lori Feldman, PhD
School of Management
Purdue University Calumet
Hammond, Ind

Alice Gilman-Sachs, PhD; Kenneth Beaman, PhD
Department of Microbiology and Immunology
Finch University of Health Sciences/The Chicago Medical School
Chicago

1. Steinberg MH, Barton FB, Castro O, et al. Effect of hydroxyurea on mortality and morbidity in adult sickle cell anemia: risks and benefits up to 9 years of treatment. JAMA. 2003;289:1645-1651. FREE FULL TEXT 2. Weiner DL, Brugnara C. Hydroxyurea and sickle cell disease: a chance for every patient. JAMA. 2003;289:1692-1694. FREE FULL TEXT 3. Venigalla P, Motwani B, Allen S, et al. A patient on hydroxyurea for sickle cell disease who developed an opportunistic infection. Blood. 2002;100:363. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290:752-753.

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