CMV Esophagitis in HIV

A 34-year-old man with newly diagnosed HIV (CD4 32 cells/µL, VL 480,000 copies/mL) presents with two weeks of severe odynophagia, retrosternal pain, and weight loss. He failed a 5-day trial of fluconazole. Upper endoscopy reveals multiple large linear deep ulcers in the distal esophagus with a clean base and normal surrounding mucosa. Biopsies from the ulcer base show large endothelial and stromal cells with owl-eye intranuclear inclusions and granular cytoplasmic inclusions; immunohistochemistry confirms CMV. Which of the following management approaches is most appropriate for the condition shown at **A** in the diagram?