CMV oesophagitis is treated with ganciclovir 5 mg/kg bd iv for 2–4 weeks, or until symptoms/signs have resolved (category III recommendation) [14,15]. Valganciclovir may be substituted for iv ganciclovir at 900 mg bd orally for some or all of the duration if symptoms are not severe enough to interfere with oral absorption on the basis of studies showing efficacy for CMV disease in transplant patients [16] but there is a paucity of data in HIV-related CMV disease of the gastrointestinal tract (category IV recommendation). Secondary CMV prophylaxis for oesophageal disease is

not routinely indicated, Bafilomycin A1 in vitro unless there is concomitant ophthalmological disease. Herpes simplex oesophagitis is treated with aciclovir 5–10 mg/kg tid iv, followed by 400 mg five times a day orally for a total of 14 days (category III recommendation) [17] or oral valaciclovir CYC202 chemical structure 1 g bd orally (see 6 Herpes viruses for a discussion of prophylaxis of HSV). Foscarnet 90 mg/kg bd iv has been used in cases

of ganciclovir-resistant CMV or 40 mg/kg bd or tid for aciclovir-resistant HSV [15]. After presentation with infectious oesophagitis, early initiation of HAART should be considered (category IV recommendation) [18]. As elsewhere in these guidelines, early initiation of HAART is favoured on the basis that improved survival without AIDS progression or death has been seen when HAART is initiated within the first two Sinomenine weeks of treatment of the opportunistic infection [18]. This recommendation is extrapolated from a series in which most cases were not related to oesophageal opportunistic infection but is also supported by evidence of functional immunological benefits of antiretrovirals against organisms such as Candida spp. [19]. Diarrhoea is a common problem for people with HIV in both resource-poor and resource-rich settings, regardless of antiretroviral exposure. In the pre-HAART

era, 30–70% of HIV-seropositive individuals experienced diarrhoea, and among European patients with CD4 counts <50 cells/μL, 49% would expect to develop diarrhoea within 1 year and 96% within 3 years [20]. In resource-poor areas, incidence and severity continue to be higher. Early clinical observations confirmed that diarrhoeal illness was linked to reduced quality of life and poorer survival [21]. Diarrhoea may be the presenting symptom of lymphoma and Kaposi’s sarcoma, may affect up to 40–50% of those taking antiretroviral therapy (ART), can be induced by other medications and may be the result of an incompletely defined direct effect of HIV on the gut mucosa termed HIV-associated enteropathy [22–25].