HIV oesophagitis

Dr Henry Knipe and Maria A. Bedoya et al.

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

The actual incidence and prevalence of Idiopathic oesophagitis of HIV are unknown. Most of the patients have acquired immunodeficiency syndrome (AIDS) and CD4 count <100 3.

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

It can be accompanied by oral ulcers and maculopapular rash in the upper body 2

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

Oesophageal biopsy shows an inflammatory reaction at the level of the ulcer with negative PAS and immunohistochemical tests for CMV and Herpesvirus 4. Idiopathic oesophagitis of HIV is a diagnosis of exclusion. 

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

  • HIV antiretrovirals
  • oral steroids

The condition improves with an increasing CD4 count.

Idiopathic oesophagitis of HIV is often indistinguishable from CMV oesophagitis 1,3. Endoscopic evaluation with tissue sampling is imperative in HIV-patients with giant oesophageal ulcers to differentiate these two entities as CMV is treated with antiviral medication that can be relatively toxic 1.     

Oesophageal pathology
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Article information

rID: 53965
Synonyms or Alternate Spellings:
  • Idiopathic oesophagitis of HIV
  • Hiv esophagitis
  • Idiopathic esophageal ulceration in human immunodeficiency virus
  • Idiopathic esophagitis of HIV
  • Idiopathic oesophageal ulceration in human immunodeficiency virus

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