CMV in HIV patients

Clinical Manifestations

Gastrointestinal Disease

• Esophagitis, with odynophagia, fever, nausea, retrosternal burning
• Gastritis, with retrosternal and epigastric burning, rarely GI bleed
• Enteritis, with abdominal pain and diarrhea
• Colitis (most common end-organ disease after retinitis, with fever, weight loss, anorexia, malaise, and abdominal pain
  • Sporadic, explosive watery diarrhea
  • May have tenesmus and hematochezia
• Can also affect oropharynx and anus, with superficial painful ulcers

Retinitis

• See also CMV retinitis in HIV patients

Management

• All patients should be started on ART
• Ganciclovir 5 mg/kg q12h for 3 to 6 weeks of induction therapy, and until symptoms resolve
  • Once tolerating oral therapy, or if disease is mild, can use valganciclovir 900 mg PO bid
• Maintenance valganciclovir should be continued in patients with CMV retinitis or if there is a relapse after induction
• The alternative agent for induction if foscarnet 60 mg/kg q8h or 90 mg/kg q12h