CMV in HIV patients
From IDWiki
Revision as of 13:26, 21 July 2022 by Aidan (talk | contribs) (Created page with "==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 hematochezi...")
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
