Herpes Simplex Esophagitis in Patients with AIDS: Report of 34 Cases

Abstract

Herpetic esophagitis (HE) associated with human immunodeficiency virus (HIV) is a rare condition mainly reported as isolated cases. We thus decided to study this association and analyze the possible predisposing factors, clinical and endoscopic presentations, and clinical response to treatment. Thirty-four HIV-1-infected patients were identified: 27 had histologically or virologically confirmed HE and seven had probable HE, a retrospective diagnosis based on the efficacy of acyclovir given alone. The median CD4 cell count was 15/mm3. Recent predisposing factors (such as nasogastric procedures, steroid therapy, and anticancer therapy) were noted with regard to 16 of the 34 patients (47%). Odynophagia and/or chest pain occurred in 30 patients (88%). At the time of diagnosis of HE, extraesophageal herpes was found in only 13 patients (38%). Superficial ulcers of the distal third of the esophagus were present in 17 (50%). Among 20 of the 27 patients with confirmed HE that could be evaluated, therapy with acyclovir led to complete resolution in 16 and partial response in 3; 1 patient died of HE. Five patients (15%) suffered confirmed or possible relapses. The mean interval between the diagnosis of HE and death was 8.8 months. Herpes simplex virus may be responsible for ulcerated esophagitis that occurs in the advanced stages of AIDS and that can be safely treated with acyclovir before a definitive diagnosis is made.

Herpes simplex virus and the alimentary tract

“…Of the remaining 20 patients, 16 (80%) had complete response to acyclovir, 3 (15%) had a partial response, and only 1 treatment failure (5%) was documented. No side effects of acyclovir were documented [ 16 ].…”

“…HSV esophagitis is more common in the immunocompromised patient and is a defi ning illness for AIDS [ 16 ]. Esophageal disease occurs in about 30% of patients with HIV infection; the esophagus is the viscus most commonly involved in disseminated HSV [ 16 , 17 ].…”

“…Over 80% of patients complained of odynophagia or dysphagia, 68% had chest pain, and 44% had fever [ 16 ]. However, symptoms may be more severe in AIDS patients, with case reports of esophageal perforation and tracheoesophageal fi stulas in the literature [ 20 , 21 ].…”

Diagnostik und Therapie der HIV-assoziierten Ösophagitis

“…3) präsentiert sich ähn-lich der CMV-assoziierten Form. Zu den häufigsten klinischen Manifestationen zählen Odyno-und Dysphagie (82 %), daneben Brustschmerzen (68%) und Fieber (44%) [18]. Gastrointestinale Blutungen sind selten und finden sich dann vor allem bei Patienten mit einer Thrombozytopenie [17,18].…”

The therapy of gastrointestinal infections associated with the acquired immunodeficiency syndrome

“…81,83 Absorption of oral acyclovir is inconsistent and may be <30%; 84 thus for patients with more severe disease, a higher dose may be required. Intravenous administration should be used when severe odynophagia limits oral intake or when the patient has not responded to high-dose oral therapy.…”