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: sulfa (sulfonamides) attending: chief complaint: chest pain major surgical or invasive procedure: cardiac catheterization avr(mech)mvrepair/asc ao replacement/cabgx4/iabp placement history of present illness: mr. is a 52-year-old man with aids (cd4 114, vl undetectable per pt's report), hepatitis c, multivessel cad, bicuspid aortic valve, + aortic insufficiency, class heart failure, who recently moved from to ma for medical care and now presents with increasing cp. pt reports a history of chronic stable angina: sscp that occurs w/ exertion, associated w/ nausea, diaphoresis & lightheadedness. relieved w/ rest and sl nitro. he has been under significant stress recently w/ his move from mo to ma. his mother is also sick and currently hospitalized. over the last few days to week, the pt has been having daily cp (more frequently than previously). on day of presentation, he had his typical angina w/ exertion in the am, which was releived w/ sl nitro. then, during the evening, while visiting his mom in the hospital, he experienced his usual sx's, but at rest. his pain, again, resolved w/ sl nitro. he went to the hosp ed for evaluation. ekg showed sr, q waves in i & avl, twi/biphasic ts in i & i &avl, & tw flattening in v6. he was transferred to as he is in the process of getting evaluated for possible cabg, mvr, & avr--he has already seen his new cardiologist dr. and has an appointment on w/ ct surgeon, dr. . . in ed, 98, 50, 115/71, 20, 99% on ra. ekg was unchanged from that done at hosp. he was cp free. he was given 325mg asa (he'd already taken his bblocker & plavix). heparin was not started as pt was pain free & reported h/o of easy bleeding. . on review of systems, pt reports recent dental work w/ teeth extraction. had flu sx's prior to dental work. got flu shot. he denies any prior history of stroke, tia, deep venous thrombosis, pulmonary embolism. he does occas have nose bleeds, asa was stopped b/c of this. no myalgias, joint pains, cough, hemoptysis, black stools or red stools. he denies recent fevers, chills or rigors. he denies exertional buttock or calf pain. all of the other review of systems were negative. *** cardiac review of systems is notable for absence of chest pain at present. he does have dyspnea on exertion p ~1block. no paroxysmal nocturnal dyspnea, orthopnea, ankle edema, palpitations, syncope or presyncope. past medical history: cad s/p multiple mis per pt's report, the last in was an ami w/ chf (in mo) -bicuspid aortic valve -+ aortic insufficiency with left ventricular dilatation -3+ mitral regurgitation. -aids, dx'd w/ hiv in , had pcp , on haart, has had chronically low cd4 (<200), though vl undetectable, on dapsone -hepatitis c (untreated)--has osh hepatologist who will start tx after pt has heart surgery - s/p appy - depression social history: unemployed, lives with male partner. smoked ppd x 35 years quit 1 month ago, + h/o marijuana use (until 1 mo ago, recreational), but no ivdu. he reports being a "terrible alcoholic," saying he was at the bar daily from open to close and drank bourbon and coke--approx 1 gallon bourbon/day x 25 years, sober x 7 years. family history: cad, alcoholism physical exam: admission vs - 98.3, 48, 114/81, 18, 96% on 2l wt 167.8lb gen: wdwn middle aged male in nad. oriented x3. mood, affect appropriate. heent: ncat. sclera anicteric. perrl, eomi. conjunctiva were pink, no pallor or cyanosis of the oral mucosa. no xanthalesma. neck: supple with jvp of 6 cm. cv: rr, 3/6 sem radiating from the left upper sternal border to the neck & ~ diastolic murmur heard throughout precordium. no s3 or s4. chest: no chest wall deformities, scoliosis or kyphosis. resp were unlabored, no accessory muscle use. ctab, no crackles, wheezes or rhonchi. abd: soft, ntnd. no hsm or tenderness. ext: no c/c/e. skin: no stasis dermatitis, ulcers, scars, or xanthomas. . pulses: right: dp 2+ pt 2+ left: dp 2+ pt 2+ pertinent results: 12:04am blood wbc-3.5* rbc-3.82* hgb-12.2* hct-35.0* mcv-92 mch-32.0 mchc-34.9 rdw-14.1 plt ct-84* 06:40am blood wbc-4.0 rbc-3.53* hgb-11.0* hct-32.1* mcv-91 mch-31.3 mchc-34.3 rdw-14.3 plt ct-97* 09:05am blood pt-13.2 ptt-35.1* inr(pt)-1.1 06:40am blood wbc-3.6* lymph-40 abs -1440 cd3%-84 abs cd3-1204 cd4%-11 abs cd4-160* cd8%-70 abs cd8-1004* cd4/cd8-0.2* 12:04am blood glucose-102 urean-23* creat-1.0 na-142 k-4.3 cl-111* hco3-23 angap-12 06:40am blood glucose-91 urean-19 creat-0.9 na-138 k-4.0 cl-109* hco3-22 angap-11 06:40am blood alt-81* ast-69* ld(ldh)-184 alkphos-56 totbili-0.8 12:02am blood ctropnt-0.02* 12:04am blood ck-mb-3 ctropnt-0.01 09:30am blood ck-mb-notdone ctropnt-<0.01 05:45pm blood ck-mb-notdone ctropnt-<0.01 09:28pm blood ck-mb-notdone ctropnt-<0.01 06:50am blood ck-mb-notdone ctropnt-<0.01 09:00am blood ck-mb-notdone ctropnt-<0.01 06:40am blood albumin-3.5 calcium-8.8 phos-3.7 mg-1.7 12:13am blood albumin-2.4* 08:43am blood %hba1c-4.6* 11:42am urine color-yellow appear-clear sp -1.015 11:42am urine blood-neg nitrite-neg protein-neg glucose-neg ketone-neg bilirub-neg urobiln-neg ph-5.0 leuks-neg 11:42am urine rbc-0 wbc-1 bacteri-none yeast-none epi-<1 11:42am urine casthy-1* . time taken not noted log-in date/time: 10:18 am immunology chem # 69468a 10:17am. **final report ** hcv viral load (final ): 279,000 iu/ml. performed by real-time pcr. detection range: 30 - 55,000,000 iu/ml. this test was developed and its performance characteristics were determined by the clinical microbiology laboratory. it has not been cleared or approved by the u.s. food and drug administration. the fda has determined that such clearance or approval is not necessary. this test is used for clinical purposes. it should not be regarded as investigational or for research.. if hcv genotype on patient's sample is desired, please contact laboratory at ext. within two weeks. . abdomen u.s. (complete study) 10:35 am abdomen u.s. (complete study) reason: assess for liver cirrhosis, splenomegaly medical condition: 52 year old man with aids/hepc scheduled for cabg. reason for this examination: assess for liver cirrhosis, splenomegaly clinical history: 52-year-old male with aids, hepatitis c scheduled for cabg. evaluate for liver cirrhosis, splenomegaly. comparison: none. abdominal ultrasound: the liver shows no focal or textural abnormality. no stone is identified within the gallbladder, which is contracted. the common duct measures 2 mm. the portal vein is patent with hepatopetal flow. the retroperitoneal structures, including the pancreas, are obscured by bowel gas. the right kidney measures 10.8 cm. the left kidney measures 11.5 cm. there is no hydronephrosis, solid mass, or stone. a 1.6 x 1.7 x 2.3 cm cyst is identified within the upper pole of the right kidney. the spleen is enlarged and measures 17 cm. no ascites is demonstrated. impression: 1. the liver shows no focal or textural abnormality. 2. splenomegaly. . comments: 1. coronary angiography of this right dominant system revealed three vessel coronary artery disease. the lmca had a mid 20% stenosis and a distal eccentric 40-50% lesion. the lad was heavily calcified; the proximal lad had a 30% lesion with diffuse plaquing. the mid lad had a tubular calcified 80% lesion involving the origin of d1 to 70%. the mid to distal lad was diffusely diseased with a subtotally occluded major d2. the lcx was moderately to heavily calcified and diffusely diseased with a 65% stenosis at the origin. the mid lad had a 65% stenosis after a high om1 branch. the om2 was diffusely diseased with timi 2 flow. the distal lcx was diffusely diseased to 60% into the lpl. the rca was heavily calcified with a proximal 50% stenosis. the mid vessel was diffusely diseased (up to 80% stenosis). the distal rca had diffuse plaquing before and after the r-pda and supplied two modest length rpl branches. 2. resting hemodynamics revealed elevated right and left sided filling pressures with rvedp and lvedp of 34 mm hg. pulmonary artery systolic pressure was severely elevated with pasp of 75 mm hg. mean pcwp was elevated with mean 27 mm hg. cardiac index was mildly depressed at 2.37 l/min/m2. 3. aortic valve area was calculated at 0.65 cm2, with mean gradient of 73 mm hg. valve area cannot be fully and accurately calculated in the setting of aortic and mitral regurgitation (calculated value is an underestimate of true value). 4. left ventriculography was not performed. a heavily calcified aortic valve with some movement of the aortic valve leaflets was appreciated. final diagnosis: 1. three vessel coronary artery disease. 2. severe aortic stenosis. 3. severe biventricular diastolic heart failure. 4. severe pulmonary arterial hypertension. . echo: the left atrium is mildly dilated. there is moderate symmetric left ventricular hypertrophy. overall left ventricular systolic function is low normal (lvef 50%) secondary to hypokinesis of the inferior and posterior (inferolateral) walls. tissue doppler imaging suggests an increased left ventricular filling pressure (pcwp>18mmhg). there is no ventricular septal defect. the remaining left ventricular segments contract normally. right ventricular chamber size and free wall motion are normal. the aortic root is mildly dilated at the sinus level. the ascending aorta is mildly dilated. the number of aortic valve leaflets cannot be determined. the aortic valve leaflets are severely thickened/deformed. there is moderate to severe aortic valve stenosis (area 0.8-1.0cm2). mild to moderate (+) aortic regurgitation is seen. the mitral valve leaflets are mildly thickened. there is no mitral valve prolapse. moderate (2+) mitral regurgitation is seen. the tricuspid valve leaflets are mildly thickened. the estimated pulmonary artery systolic pressure is normal. there is a trivial/physiologic pericardial effusion. there are no echocardiographic signs of tamponade. echocardiography report , (complete) done at 10:31:36 am preliminary referring physician information , , status: inpatient dob: age (years): 52 m hgt (in): bp (mm hg): / wgt (lb): hr (bpm): bsa (m2): indication: coronary artery disease. h/o cardiac surgery. left ventricular function. mitral valve disease. prosthetic valve function. right ventricular function. valvular heart disease. icd-9 codes: 440.0, v43.3 test information date/time: at 10:31 interpret md: , md test type: tee (complete) son: , md doppler: full doppler and color doppler test location: anesthesia west or cardiac contrast: none tech quality: adequate tape #: 2008aw03-: machine: echocardiographic measurements results measurements normal range left ventricle - ejection fraction: 5% to 10% >= 55% findings emergency tee performed twice during the night. attempted wean off ecmo and asssess lv and rv function with gradual ecmo wean. left ventricle: severely depressed lvef. right ventricle: mildly dilated rv cavity. severe global rv free wall hypokinesis. aortic valve: bioprosthetic aortic valve prosthesis (avr). avr leaflets move normally. no as. mitral valve: mitral valve annuloplasty ring. normal mvr leaflet motion. tricuspid valve: moderate tr. pulmonic valve/pulmonary artery: normal pulmonic valve leaflets with physiologic pr. general comments: a tee was performed in the location listed above. i certify i was present in compliance with hcfa regulations. the tee probe was passed with assistance from the anesthesioology staff using a laryngoscope. no tee related complications. suboptimal image quality - poor suprasternal views. suboptimal image quality - bandages, defibrillator pads or electrodes. suboptimal image quality as the patient was difficult to position. suboptimal image quality - body habitus. suboptimal image quality - ventilator. image quality was suboptimald - poor esophageal contact. suboptimal image quality. suboptimal image quality - patient unable to cooperate. regional left ventricular wall motion: n = normal, h = hypokinetic, a = akinetic, d = dyskinetic conclusions overall left ventricular systolic function is severely depressed (lvef= xx %). the right ventricular cavity is mildly dilated with severe global free wall hypokinesis. a bioprosthetic aortic valve prosthesis is present. the aortic valve prosthesis leaflets appear to move normally. there is no aortic valve stenosis. a mitral valve annuloplasty ring is present. the motion of the mitral valve prosthetic leaflets appears normal. moderate tricuspid regurgitation is seen. suboptimal image quality - patient unable to cooperate. lv/rv function remained severely depressed during the wean process and increasing doses of inotropes. interpretation assigned to , md, interpreting physician brief hospital course: 52yo man w/ aids, hepatitis c, cad s/p mi, bicuspid av w/ severe ar & mr, w/ h/o chf (ef unkown) who presents w/ escalating chest pain. ct surgery evaluated the patient and scheduled cabd and valve replacement/repair surgery for friday . his pre-op evaluation entailed undergoing cardiac catheterization which demonstrated severe as (area 0.6 cm2), wedge of 27 mm hg, 3vd, distal lm 40-50% stenosis, lad 70-80% stenosis, lcx 60% stenosis and rca diffuse disease to 80% stenosis. hepatology was also consulted regarding his surgical risks associated with his liver disease. he was classified as being child's class a based on their evaluation. the patient's outpatient infectious disease records were also obtained regarding his surgical clearance in terms of his aids status. preoperatively while awaiting surgery he developed on and off chest pain which was relieved with nitroglycerine. early morning of , at 1:30am, the patient developed chest pain, accompanied by hypotension and st elevations on ekg. he was transferred to the ccu where he became unresponsive and sufferred a cardiac arrest was resuscitated with chest compreessions for about 45 minutes with no response. he was placed on ecmo at the bedside in the intensive care unit following which a decision was made to proceed with the operation given his young age though he had already had cardiac arrest for a substantial period. he was emergently brought to surgery to undergo valve replacement and cabg. #. hiv: on haart, has had chronically low cd4 (<200), with undetectable viral load. . # hep c: the patient has never received therapy for his hepatitis c. outside records of a liver biopsy in demonstrated steatosis, lymphocytic infiltration of portal triads with piecemeal necrosis and lobular inflammation. 1+ iron. trichrome stain with expansion of portal triads with portal-to-portal and portal-to-central vein bridging and fibrosis surrounding single cells. no regenerative nodules. diagnosis: chronic hepatitis, grade 3, stage 2 consistent with hcv infection. abdominal ultrasound showed splenomegaly a liver with normal contours. as described above patient developed chest pain and sufferd an anterior mi followed by cardiac arrest he was brought emergently to the operating room on ecmo for avr/mvr/asc ao repair/cabg. please see or report for details. post cardiopulmonary bypass he had difficulty maintaining oxygen saturation and was placed on a venovenous ecmo. this was successful in maintaining oxygen saturations and he was transferred to the cardiac surgery unit on ecmo and multiple pressors with an open chest. on the night of surgery he sustained a cardiac arrest again and underwent open chest cardiac massage and was succesfully resuscitated. over the next twenty four hours he was successfully weaned off the ecmo and maintained saturations. he had a few chest wash outs during this time to clear fluid accumulation in the chest. the next day he again sustained another cardiac arrest and this time could not be resuscitated by internal cardiac massage and was placed on arteriovenous ecmo as a last option. after about 24 hours of this support an attempt was made to wean off ecmo and was unsuccessful. he developed bilatereal lower limb ischemia in the meantime and was in acute renal failure on hemofiltration on multiple high doses of inotropes. given the futility of the situation after discussion with the family the ecmo support was stopped and the patient died soon after. patient was pronounced by dr at 13.26. medications on admission: lisinopril 40 mg daily lovastatin 20 mg daily lopinavir-ritonavir 2 tab po bid plavix 75 mg daily metoprolol 100 mg dapsone 100 mg daily ranitidine 150 mg daily truvada 1 tab daily trazodone 150 mg qhs nitro patch 0.2 mg hs discharge medications: expired discharge disposition: expired discharge diagnosis: expired discharge condition: expired discharge instructions: expired followup instructions: expired md procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified (aorto)coronary bypass of three coronary arteries single internal mammary-coronary artery bypass extracorporeal circulation auxiliary to open heart surgery combined right and left heart cardiac catheterization coronary arteriography using two catheters diagnostic ultrasound of heart insertion of endotracheal tube hemodialysis other bronchoscopy open and other replacement of aortic valve resection of vessel with replacement, thoracic vessels implant of pulsation balloon cardiopulmonary resuscitation, not otherwise specified open heart valvuloplasty of mitral valve without replacement extracorporeal membrane oxygenation [ecmo] diagnoses: thrombocytopenia, unspecified coronary atherosclerosis of native coronary artery pure hypercholesterolemia acute kidney failure with lesion of tubular necrosis congestive heart failure, unspecified unspecified essential hypertension diabetes mellitus without mention of complication, type ii or unspecified type, not stated as uncontrolled acute myocardial infarction of other anterior wall, initial episode of care unspecified viral hepatitis c without hepatic coma other chronic pulmonary heart diseases mitral valve insufficiency and aortic valve insufficiency human immunodeficiency virus [hiv] disease cardiogenic shock old myocardial infarction congenital insufficiency of aortic valve diastolic heart failure, unspecified splenomegaly mixed acid-base balance disorder 

Answer: The patient is high likely exposed to