HIV oesophagitis is a possible cause of odynophagia in immunosuppressed patients with HIV.
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Epidemiology
The actual incidence and prevalence of idiopathic oesophagitis of HIV are unknown. Most of the patients have AIDS and a CD4 count <100 cells/mm3 3.
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 2.
Pathology
Oesophagitis 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.
Radiographic features
Fluoroscopy / barium studies
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.
Treatment and prognosis
- antiretroviral therapy (ART)
- oral steroids
The condition improves with an increasing CD4 count.
Differential diagnosis
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.