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HIV Odynophagia / Esophagitis
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Empirical fluconazole for mild; endoscopy for severe.
Decision
Outcome
Decision
HIV+ with dysphagia/odynophagia. Initial step?
✓
Mild symptoms with oral thrush → empiric fluconazole, observe for response
✓
Severe symptoms or no thrush → endoscopy with biopsy
Outcome
Fluconazole 100–200 mg/day; check if no improvement, scope
Decision
Endoscopy finding?
✓
White plaques → Candida
✓
Large linear ulcers → CMV
✓
Vesicles or small round/ovoid ulcers → HSV
✓
Aphthous ulcers → idiopathic / HIV
Outcome
IV ganciclovir; reduce HIV viral load
Outcome
Acyclovir
Outcome
Symptomatic; consider thalidomide if severe
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