HIV esophagitis

HIV esophagitis is a possible cause of odynophagia in immunosuppressed patients with HIV.

Epidemiology

The actual incidence and prevalence of idiopathic esophagitis of HIV are unknown. Most of the patients have AIDS and a CD4 count <100 cells/mm(= <100 cells/μL) .

Clinical presentation

Principal clinical presentation is odynophagia, dysphagia or retrosternal chest pain.

It can be accompanied by oral ulcers and a maculopapular rash in the upper body .

Pathology

Esophagitis in HIV patients with low CD4 counts is usually caused by an infectious etiology, such as cytomegalovirus (CMV), Herpes virus or Candida. However, there are cases where the etiology is not identified in cultures, electron microscopy, or immunohistochemical tests. In these cases, HIV itself has been proposed to be etiology.

Esophageal biopsy shows an inflammatory reaction at the level of the ulcer with negative PAS and immunohistochemical tests for CMV and Herpesvirus . Idiopathic esophagitis of HIV is a diagnosis of exclusion.

Radiographic features

Fluoroscopy / barium studies

Usually presents as an oval or diamond-shaped flat giant esophageal ulcer, with or without small satellite ulcers. Double-contrast esophagogram may show edema represented as a peripheral radiolucent rim.

Treatment and prognosis

• highly active antiretroviral therapy (HAART)
• oral steroids

The condition improves with an increasing CD4 count.

Differential diagnosis

• CMV esophagitis
• Herpes esophagitis
• Candida esophagitis

Idiopathic esophagitis of HIV is often indistinguishable from CMV esophagitis . Endoscopic evaluation with tissue sampling is imperative in HIV-patients with giant esophageal ulcers to differentiate these two entities as CMV is treated with antiviral medication that can be relatively toxic .