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Gastrointestinal Disorders in HIV-Infected Patients

Gastrointestinal symptoms are common in AIDS patients. Weight loss is universal, and 70% of patients will note significant diarrhea. Dysphagia or odynophagia occurs in 20-25% of patients.

HIV-Related Esophageal Disease

Painful swallowing indicates esophageal disease, which can be so disabling that it leads to severe weight loss and malnutrition, accelerating the wasting syndrome. Risk for esophageal candidiasis begins at CD4 counts below 200 cells/ÁL.

The same organisms or processes that cause oral lesions in patients with HIV infection also cause esophageal disease. Candida albicans is the most common cause of esophagitis.

Other less common causes of esophagitis include herpes simplex virus and cytomegalovirus.

Empiric Management of Esophagitis

An empiric 2-3 week course of systemic oral esophagitis fluconazole (Diflucan) is typically curative, although there is a high relapse rate. Lifelong therapy with fluconazole is often required to prevent recurrence.

If systemic antifungal therapy is ineffective, empiric treatment for herpes with acyclovir may be prescribed.

Endoscopy with biopsy is indicated for patients who do not respond to empiric therapy.