Consider the following medical report that includes the patient's historical health records. Use it to predict the disease that the patient is high likely exposed to. 

 Medical Report: allergies: ampicillin attending: chief complaint: symptomatic anemia major surgical or invasive procedure: none history of present illness: pt is a 58yo female with history of hiv (last cd4 246, vl 303 in ), hepatitis c cirrhosis, esrd secondary to hiv nephropathy on hd, gi bleed with recent discharge on , who presents with melena. sent in today from clinic; the appt was f/u from most recent discharge. pt states that since her discharge on sunday, 4 days ago, she has continued to have black-brown stools. during her last admission, she was having black, tarry stools, but since discharge they have been more formed and black-brown. she has not had any brbpr since the beginning of her initial last admission. she has felt weak for the past few days since her discharge. she denies any sob, chest pain, chest pressure, or lightheadedness. she has been compliant on taking her omeprazole. she denies any recent nsaid use. . regarding history of gi bleed patient has been hospitalized several times in the last year and has undergone extensive work-up including colonoscopy, egd, and capsule study which were all unrevealing. during her last admission, she refused additional diagnostic workup. gib thought to be slow bleed from avm in setting of known portal hypertensive gastropathy. she was transfused 6 units of prbc's during her last admission. she was discharge on omeprazole 40mg po bid, and given follow-up with gi for further discussion of studies, etc. . in the ed, initial vs were: t 97.6 p 98 bp 90/57 r 18 o2 sat 97% ra. labs were notable for hct 18.3, prior hct 29 on discharge . cr 7.4, baseline cr , on hd. exam notable to be benign, though fatigued. sbp 84, guaiac positive brown stool, did not look like melena. pt has 2x18g iv's. pt received 1 dose of protonix 80 iv, and started on gtt. pt refused ngl. vital signs prior to transfer, hr 97 bp 88/49 rr 17 o2 sat 100%ra. . on the floor, she currently feels very weak, but has no other complaints. she had a headache earlier, but that has since improved. . she did go to hd yesterday. she felt slightly cold the last few days but denied any fever. she says she has had a good appetite and has been taking good po fluids. . review of systems: (+) per hpi. also with some mild nasal drainage. (-) denies fever, night sweats, recent weight loss or gain. denies headache, sinus tenderness, rhinorrhea or congestion. denies cough, shortness of breath, or wheezing. denies chest pain, chest pressure, palpitations, or weakness. denies nausea, vomiting, diarrhea, constipation, abdominal pain. denies dysuria, frequency, or urgency. denies arthralgias or myalgias. past medical history: - esrd due to hiv nephropathy on hd tuthsa - hiv, diagnosed ; last cd4 246, vl: - hepatitis c with cirrhosis and portal hypertension - zoster - bronchitis - gib - chronic, thought to be due to avm - thrombocytopenia social history: patient is on disability. lives with adult son; has 5 adult children. tob: >25 pack-year tobacco history, currently smokes few cigarrettes/day. etoh: denies etoh use. none for several years since diagnosis of cirrhosis. drugs: history of crack cocaine use and ivdu (last use 10 yrs ago); stopped since starting dialysis ~. family aware of hiv diagnosis. uses marijuana occasionally, last used yesterday. family history: mother with dm and htn; died from brain aneurysm. gm with dm, htn; died from diabetic coma. older sister died of liver cancer. sister w/ breast cancer; in remission no history of colon cancer. no history of bleeding disorders or gib. physical exam: admission: vitals: t: 96.5 bp: 99/64 p: 101 r: 13 o2: 100% 2l general: alert, oriented, appears fatigued, nad heent: sclera icteric, + conjunctival pallor, dry mm neck: supple, jvp not elevated, no lad lungs: no use of accessory of muscles, scattered crackles bilaterally at bases, no wheezes, rales, ronchi cv: regular rate and rhythm, normal s1 + s2, 4/6 systolic murmur heard best at llsb without radiation, no rubs, gallops abdomen: soft, non-tender, mildly distended, bowel sounds present, no rebound tenderness or guarding, no organomegaly ext: warm, well perfused, 2+ pulses, no clubbing, cyanosis or edema neuro: a&ox3, cn ii-xii grossly intact, moving all extremities, no focal deficits pertinent results: admission labs: 08:05pm glucose-101* urea n-40* creat-7.4* sodium-140 potassium-4.2 chloride-100 total co2-27 anion gap-17 08:05pm alt(sgpt)-7 ast(sgot)-15 ld(ldh)-163 alk phos-60 tot bili-0.2 08:05pm haptoglob-70 08:05pm wbc-5.4 rbc-2.00*# hgb-5.9*# hct-18.3*# mcv-92 mch-29.7 mchc-32.4 rdw-17.8* 08:05pm pt-15.0* ptt-24.1 inr(pt)-1.3* ruq us w doppler: findings: the liver is normal in echogenicity and no focal liver lesion is identified. no biliary dilatation is seen and the common duct measures 0.3 cm. the gallbladder contains a tiny 4 mm stone. the pancreas is unremarkable; however, the distal tail is obscured from view by overlying bowel. the spleen is unremarkable and measures 11.3 cm. a scant trace of ascites is seen posterior to the spleen. doppler examination: color doppler and pulse-wave doppler images were obtained. the main, right and left portal veins are patent with hepatopetal flow. appropriate flow is seen in the splenic vein, smv, hepatic veins, and hepatic arteries. impression: 1. patent hepatic vasculature. 2. no focal liver lesion and no biliary dilatation. 3. scant trace of ascites. 4. cholelithiasis discharge labs: 07:53am blood wbc-5.4 rbc-3.42* hgb-10.2* hct-31.1* mcv-91 mch-30.0 mchc-32.9 rdw-18.0* plt ct-148* 07:53am blood glucose-133* urean-37* creat-7.6*# na-136 k-3.8 cl-99 hco3-24 angap-17 07:53am blood calcium-8.8 phos-4.5 mg-1.9 brief hospital course: micu course: pt is a 58yo female with history of hiv, hepatitis c cirrhosis, esrd secondary to hiv nephropathy on hd, presenting with possible melena and hct drop. . # acute on chronic anemia: most likely to acute on chronic gib. possible melena reported, vs. brown stool that was guaiac positive. hct drop likely bleed from avm in setting of known portal hypertensive gastropathy per prior diagnosis. extensive work-up to date (c-scope, egd, tagged rbc) unable to localize source of bleed. baseline hct 26, last discharged on with hct 29. now presents with admission hct 18. other possible ddx for hct drop would be hemolysis coagulopathy. however, coags were at baseline (inr 1.2-1.3), and hemolysis labs were negative. she was transfused 5 units and her hct bumped appropriately. she was started on protonix gtt overnight in the micu. gi followed, and recommended a cta abdomen if the pt's hematocrit were to drop, which it did not. # esrd secondary to hiv nephropathy: on hd tuthsa. last had hd day prior to admission. hd team notified of her admission. she was continued on nephrocaps & sevelamer. continued on epo & zemplar with hd . # hiv: non-complaint with haart per previous admission information. last cd4: 246 vl:303 copies/ml in 3/. discharged on tenofovir, etravirine, and lamivudine. pt has missed at least one dose since recent discharge. restarted on haart meds and bactrim for pcp . id team notified of admission. . # hepatitis c cirrhosis: last vl:201,000 iu/ml in 3/. synthetic function stable. inr: 1.3 on admission. last screening abd us in wnl. gi followed as above. & & & & & & & & & & & & & & & & & & & & & &&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&& medical wards course: pt was stabilized and resuscitated appropriately in the micu with 5u prbc's, on icu day one was found to be hd stable with no evidence of declining hct. she was then transferred to the medical floor in stable condition. active issues: 1) melena - gi believed the source was either a portal gastropathy or avm - these have been visualized on endoscopy and capsule study but every time they perform egd or colonoscopy with intent to intervene there has been no actively bleeding lesion found - per gi notes the pt had also been refusing any further endoscopy (push or spiral endoscopy) that could provide an answer - pt experienced melena x3 overnight on wards day 0-1, but hct did not decrease and pt did not become more tachycardic, hypotensive etc to suggest any active bleeding - her melena was therefore thought to be clearing of the old blood in her gi tract from her prior bleed - gi recommended a cta abdomen if the pt were to develop a decline in her hct to suggest active bleeding, but the patient's hct remained stable - pt will require close follow up and hct measurements at hd, and then will need a way to be transfused on an as needed basis if she continues to refuse any interventional procedure - we have arranged for her to have her hct checked at dialysis, and then the pt will be sent to the pheresis unit for intermittant transfusions at the direction of the renal team 2) hiv nephropathy - pt receives hd tts, last dialyzed successfully on thurs for 2l uf - continued nephrocaps, sevelamer, epo, zemplar 3) hcv cirrhosis - leading theory as to etiology of the pt's bleed was portal hypertension leading to gastropathy - underwent ruq us that showed hepatopetal flow in the main and r/l portal veins with no evidence of thrombosis or abnormality of the liver architecture - pt currently without ascites or encephalopathy, recent egd showing no varices but portal gastropathy - admission labs showed inr 1.2, alb 3.0, cr 8.0, tbili 1.2 giving a meld unos of 22 - last vl:201,000 iu/ml in - pt at this time appears to be well compensated and therefore did not require any treatment for this problem while in house 4) hiv - pt has not been compliant with her regimen per admission notes - last cd4: 246 vl:303 copies/ml in - continued lamivudine, etravirine, viread - continued bactrim at hd for pcp notified dr. of her medication noncompliance and instructed the patient to take her medications more diligently. transition of care: - pt will have her hct checked by the renal team at dialysis, and then they will arrange for her to have blood tranfusions on an as needed basis - pt will have a follow up appointment with dr. to discuss her compliance with her haart regimen - pt will have fu with the gi team to discuss any potential management or intervention for her chronic, occult gi bleed *****note***** the patient left the hospital on saturday without staying long enough to be properly discharged and therefore did not have her discharge paperwork. her official post discharge instructions were given to her verbally by the house staff medications on admission: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation q6h (every 6 hours) as needed for sob, wheeze. 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po qfri (every friday). 4. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po 3x/week (tu,th,sa). 5. etravirine 100 mg tablet sig: two (2) tablet po bid (2 times a day). 6. sevelamer hcl 400 mg tablet sig: two (2) tablet po tid w/meals (3 times a day with meals). 7. lamivudine 100 mg tablet sig: 0.5 tablet po once a day. 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. . pt has missed a dose of her hiv meds. has not been taking nephrocaps. discharge medications: 1. albuterol sulfate 90 mcg/actuation hfa aerosol inhaler sig: 1-2 puffs inhalation every six (6) hours as needed for shortness of breath or wheezing. 2. b complex-vitamin c-folic acid 1 mg capsule sig: one (1) cap po daily (daily). 3. tenofovir disoproxil fumarate 300 mg tablet sig: one (1) tablet po qfri (every friday). 4. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po qhd (each hemodialysis). 5. etravirine 100 mg tablet sig: two (2) tablet po bid (2 times a day). 6. sevelamer hcl 400 mg tablet sig: one (1) tablet po tid w/meals (3 times a day with meals). 7. lamivudine 100 mg tablet sig: 0.5 tablet po once a day. 8. omeprazole 40 mg capsule, delayed release(e.c.) sig: one (1) capsule, delayed release(e.c.) po twice a day. discharge disposition: home discharge diagnosis: gastrointestinal bleeding of unknown origin discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: ambulatory - independent. discharge instructions: this is the discharge paperwork that would have been given to the patient. she left before she could receive this. patient has been contact and asked to pick up this paperwork. dear ms. , you were admitted to the for evaluation and treatment of your gastrointestinal bleeding. when you were admitted your blood counts were very low, and you were given blood transfusions to which you responded quite well. you continued to have dark bowel movements for awhile but this was thought to be from the old bleeding as your blood counts did not decrease after your transfusion. while you were here, we discussed options that could help us find a source for your bleeding, as we know that this has been very difficult in your previous admissions. since you have requested to not undergo any more endoscopy procedures, our options are somewhat limited. if you were to develop any more rapid bleeding, we would perform an abdominal ct scan, but we can't do this unless there is a fairly rapid bleed. in the meantime, we have tried to arrange a system where you will get your blood checked at dialysis, and then the kidney doctors could get into a tranfusion unit where you could get blood cells on an as needed basis. this will not stop your bleeding but would rather give you enough blood cells to keep you from becoming short of breath or tired. medications: added: none changed: none removed: none followup instructions: your renal doctors the number below to arrange for a blood transfusion if you need one: pheresis unit if they are having trouble, they can call the nurse manager for the unit: (pheresis nurse manager) pager procedure: hemodialysis diagnoses: thrombocytopenia, unspecified end stage renal disease renal dialysis status cirrhosis of liver without mention of alcohol chronic hepatitis c without mention of hepatic coma acute posthemorrhagic anemia portal hypertension personal history of noncompliance with medical treatment, presenting hazards to health hypovolemia other specified disorders of stomach and duodenum asymptomatic human immunodeficiency virus [hiv] infection status angiodysplasia of stomach and duodenum with hemorrhage 

Answer: The patient is high likely exposed to