Insights into gastrointestinal manifestation of human immunodeficiency virus: A narrative review

Table 1 Various esophageal manifestations in patients with human immunodeficiency virus

Type	CD4 counts	Endoscopic findings	Biopsy findings	First line therapy	Alternative treatment(s)
Candidal esophagitis	< 200/uL	White plaques, exudates, mucosal lesions	Yeast with pseudohyphae, parakeratosis	Fluconazole: 200 mg loading dose, followed by 100 mg daily for 10-14 days	Isavuconazole: (200 mg load, then 50 mg daily; 400 mg load, then 100 mg daily; or 400 mg weekly), posaconazole for refractory cases (400 mg twice daily for 28 days)
CMV esophagitis	< 50/uL	Well-demarcated vertical ulcers, single or multiple	Intracellular: Inclusions with clear halo- “owl's eye" appearance	Ganciclovir: 10-15 mg/kg daily in divided doses for 3-6 weeks	Valganciclovir (oral), foscarnet for resistance, combination therapy with ganciclovir and foscarnet in case of failure
HSV esophagitis	< 200/uL	Fragile mucosa with distinct vesicles and “volcano” ulcers	Multinucleated giant cells, cowdry a inclusion bodies	Acyclovir 200 mg five times a day or 400 mg three times a day for 7-10 days	Famciclovir, valacyclovir
Idiopathic esophageal ulcers		Large single ulcers, profound depth, located mid-esophagus	Negative for infections or malignancy	Oral steroids dosages vary based on severity and patient response	Thalidomide (as a therapeutic trial in severe cases)
Pill esophagitis		Varied ulcerations along the esophageal lining	Granulation tissue, necrotic squamous epithelium, and intraepithelial eosinophils	Behavioral changes like taking medication with enough water, avoiding lying down immediately after taking pills	Prevention is key; treatment focuses on behavioral changes)