Which treatment is indicated for CMV esophagitis in HIV patients?

Cytomegalovirus (CMV) esophagitis is a common opportunistic infection in patients with advanced HIV/AIDS, particularly when the CD4 cell count is below 50 cells/mm³. The treatment of choice for CMV infections, including esophagitis, is ganciclovir given intravenously.

Ganciclovir is an antiviral medication specifically effective against CMV due to its mechanism that inhibits viral DNA synthesis. This property makes it particularly useful in managing severe CMV infections in immunocompromised individuals, including those with HIV. The intravenous route is often necessary in cases of severe disease, such as esophagitis, due to the need for rapid and effective systemic treatment.

While acyclovir is an antiviral that is used for infections caused by herpes simplex virus and varicella-zoster virus, it does not have efficacy against CMV. Fluconazole is an antifungal agent recommended for candida esophagitis and is not effective against viral infections. Valacyclovir, like acyclovir, is effective for herpes viruses but not for CMV.

Thus, the selection of ganciclovir IV is based on its effectiveness against CMV and the clinical context of HIV