- Cytomegalovirus (CMV) gastrointestinal disease is an uncommon but serious complication of AIDS.
- The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis.
- The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available
- Pill esophagitis (NSAIDs, antibiotics)
- Allergy (esoninophillic)
- Infectious Mainly seen in pts w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV, CMV esophagitis, aphthous ulceration
- Pill esophagitis common culprits:
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid
- Ganciclovir: 5mg/kg/dose IV q12h
- Foscarnet: 60mg/kg/dose q8h or 90mg/kg/dose q12h
- Valganciclovir: 900mg PO twice daily
- May be used for induction therapy, in place of intravenous ganciclovir, in patients who can tolerate and absorb oral medications
- The recommended duration of therapy for CMV gastrointestinal disease in patients with AIDS is 3-6 weeks
- Chronic maintenance therapy is not recommended for CMV gastrointestinal disease unless there is concurrent retinitis or recurrent gastrointestinal disease after induction therapy has been discontinued.
- Ganciclovir 5mg/kg IV q12hrs daily x 21 days (or until symptom resolution)
- Foscarnet 90mg/kg IV q12 hrs daily x 21 days (or until symptom resolution)