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: penicillins attending: chief complaint: fatigue major surgical or invasive procedure: re-do aortic valve replacement with 21-mm regent st. medical mechanical valve history of present illness: 59 year old male with history of endocarditis s/p avr (tissue) in with dr. . he had done well since until he recently developed fatigue and dyspnea on exertion. he had a recent admission for chf/pneumonia. echo reveals declining heart function, and increasing aortic valve gradients. he presents for surgical evaluation. past medical history: hypertension hyperlipidemia hiv, cd4 815, undetectable viral load x 12 yrs (per patient) chronic systolic heart failure endocarditis -due to cat litter (not ivdu) c/b right femoral artery embolus past surgical history: avr (tissue), repair lv aneurysm, dr. sfa->posterior tibial bypass dr. tonsillectomy social history: race: caucasian last dental exam: , calling office to fax clearance lives with: alone occupation: works part-time as hiv educator in schools and prisons tobacco: quit 9 yrs. ago etoh: quit 24yrs. ago ivdu: quit 24yrs. ago family history: mother with cad in her 70s, died at 84yo father's mom died of mi at 45yo physical exam: pulse: 88 resp: 18 o2 sat: 98%ra b/p right: 101/65 left: 97/60 height:5'4" weight:140 lbs general: nad, wgwn, appears stated age skin: dry intact heent: perrla eomi neck: supple full rom chest: lungs clear bilaterally heart: rrr irregular murmur harsh systolic ejection murmur best heard at 3rd ics/parasternal space on the left. abdomen: soft non-distended non-tender bowel sounds + extremities: warm , well-perfused edema: none varicosities: none well healed incision of the rle- median aspect ankle to groin neuro: grossly intact x pulses: femoral right: 2+ left:2+ dp right: 2+ left:2+ pt : 2+ left:2+ radial right: 2+ left:2+ carotid bruit: radiation of cardiac murmur +thrill bilaterally pertinent results: echo: pre-cpb: the left atrium is mildly dilated. no thrombus is seen in the left atrial appendage. no atrial septal defect is seen by 2d or color doppler. there is mild symmetric left ventricular hypertrophy. overall left ventricular systolic function is moderately depressed (lvef= 30-40 %). right ventricular chamber size and free wall motion are normal. there are simple atheroma in the descending thoracic aorta. no thoracic aortic dissection is seen. a bioprosthetic aortic valve prosthesis is present. there is severe aortic valve stenosis (valve area 0.8-1.0cm2). moderate (2+) aortic regurgitation is seen. trivial mitral regurgitation is seen. post-cpb: a mechanical bileaflet valve is seen in the aortic position. the valve is well seated with normal leaflet motion. the normal washing jets are seen. there is no paravalvular leak. the peak gradient across the aortic valve is 27mmhg, the mean gradient is 14mmhg with a cardiac output of 6. the lv systolic function remains moderately impaired, the estimated ef is 35-40%. hypokinesis is most notable in the anteroseptal wall. there is no evidence of aortic dissection. brief hospital course: mr. was a same day admit after undergoing pre-operative work-up prior to admission. on he was brought to the operating room where he underwent a re-do aortic valve replacement with 21- mm regent st. medical mechanical valve . please see operative report for surgical details. following surgery he was transferred to the cvicu for invasive monitoring in stable condition. within 24 hours he was weaned from sedation, awoke neurologically intact and extubated. all pressors weaned off. beta-blocker/statin/aspirin and diuresis were initiated. all lines and drains were discontinued per protocol. he was transferred to the step down unit for further monitoring. physical therapy was consulted to evaluate strength and mobility. the remainder of his hospital course was essentially uneventful. anticoagulation was intitiated with coumadin and a heparin bridge. on pod# 6 his inr was therapeutic and mr. was cleared for discharge to home with vna. all follow up appointments were advised. medications on admission: acyclovir - 400 mg tablet - one tablet(s) by mouth twice a day bupropion hcl - 150 mg tablet extended release 24 hr - one tablet(s) by mouth once daily. carvedilol - 3.125 mg tablet - 2 tablet(s) by mouth twice per day. clarithromycin - 500 mg tablet - one tablet(s) by mouth once daily. clindamycin hcl - 150mg capsule - 4 tablets one hour pre-dental work digoxin - 125 mcg tablet - one tablet(s) by mouth once daily. efavirenz - 600 mg tablet - one tablet(s) by mouth once a day at bedtime enalapril maleate - 10 mg tablet - one tablet(s) by mouth once a day fenofibrate nanocrystallized - 48 mg tablet - one tablet(s) by mouth once daily for control of elevated triglycerides. folic acid - 1 mg tablet - one tablet(s) by mouth once a day furosemide - 20 mg tablet - one tablet(s) by mouth once daily. hydrocortisone - 2.5 % ointment - apply to rash once a day lamivudine-zidovudine - 150 mg-300 mg tablet - one tablet(s) by mouth twice a day lorazepam - 0.5 mg tablet - one tablet(s) by mouth hs as needed for sleep. simvastatin - 40 mg tablet - one tablet(s) by mouth once daily for control of cholesterol. sodium fluoride - 1.1 % gel - use to brush teeth 3-4 times per day medications - otc calcium carbonate-vitamin d3 - (otc) - 500 mg-200 unit tablet - one tablet(s) by mouth once daily. lactobacillus acidophilus - (otc) - 500 million cell tablet - one tablet(s) by mouth once daily. loratadine - 10 mg tablet - one tablet(s) by mouth once a day multivitamin - (otc) - tablet - one tablet(s) by mouth once daily discharge medications: 1. hydromorphone 2 mg tablet sig: 1-2 tablets po q3h (every 3 hours) as needed for pain. disp:*60 tablet(s)* refills:*0* 2. enalapril maleate 2.5 mg tablet sig: one (1) tablet po daily (daily). disp:*30 tablet(s)* refills:*0* 3. carvedilol 6.25 mg tablet sig: one (1) tablet po bid (2 times a day). disp:*60 tablet(s)* refills:*0* 4. acetaminophen 500 mg tablet sig: 1-2 tablets po q6h (every 6 hours) as needed for pain. 5. multivitamin tablet sig: one (1) tablet po daily (daily). 6. docusate sodium 100 mg capsule sig: one (1) capsule po bid (2 times a day). 7. aspirin 81 mg tablet, delayed release (e.c.) sig: one (1) tablet, delayed release (e.c.) po daily (daily). disp:*30 tablet, delayed release (e.c.)(s)* refills:*0* 8. acyclovir 400 mg tablet sig: one (1) tablet po twice a day. 9. clarithromycin 500 mg tablet sig: one (1) tablet po once a day. 10. efavirenz 600 mg tablet sig: one (1) tablet po qhs (once a day (at bedtime)). 11. fenofibrate micronized 48 mg tablet sig: one (1) tablet po daily (). 12. folic acid 1 mg tablet sig: one (1) tablet po daily (daily). 13. lasix 20 mg tablet sig: one (1) tablet po once a day for 10 weeks. 14. lamivudine-zidovudine 150-300 mg tablet sig: one (1) tablet po bid (2 times a day). 15. lorazepam 0.5 mg tablet sig: one (1) tablet po at bedtime as needed for insomnia. 16. simvastatin 40 mg tablet sig: one (1) tablet po daily (daily). 17. dentagel 1.1 % gel sig: one (1) to tooth brush dental four times a day: use to brush teeth 3-4 times a day . 18. lactobacillus acidophilus 500 million cell tablet sig: one (1) tablet po once a day. 19. loratadine 10 mg tablet sig: one (1) tablet po daily (). 20. calcium 500 + d 500 mg(1,250mg) -200 unit tablet sig: one (1) tablet po once a day. 21. bupropion hcl 150 mg tablet extended release sig: one (1) tablet extended release po qam (once a day (in the morning)). 22. warfarin 2 mg tablet sig: goal inr 2.5-3 tablets po to be dosed based on inr : you are receiving two different doses of coumadin so that your dose can be adjusted based on lab results . disp:*60 tablet(s)* refills:*2* 23. warfarin 5 mg tablet sig: goal inr 2.5-3 tablets po to be dosed based on inr : you are receiving two different doses of coumadin so that your dose can be adjusted based on lab results . disp:*60 tablet(s)* refills:*2* 24. coumadin please take 5 mg coumadin on and then vna to check inr level on further dosing will be based on inr results cardiac surgery office will dose coumadin until set up with dr discharge disposition: home with service facility: vna of southeastern mass. discharge diagnosis: prosthetic aortic valve stenosis s/p redo-sternotomy, aortive valve replacement past medical history: hypertension hyperlipidemia hiv, cd4 815, undetectable viral load x 12 yrs (per patient) chronic systolic heart failure endocarditis -due to cat litter (not ivdu) c/b right femoral artery embolus past surgical history: avr (tissue), repair lv aneurysm, dr. sfa->posterior tibial bypass dr. tonsillectomy discharge condition: alert and oriented x3 nonfocal ambulating with steady gait incisional pain managed with dilaudid incisions: sternal - healing well, no erythema or drainage edema none discharge instructions: please shower daily including washing incisions gently with mild soap, no baths or swimming until cleared by surgeon. look at your incisions daily for redness or drainage please no lotions, cream, powder, or ointments to incisions each morning you should weigh yourself and then in the evening take your temperature, these should be written down on the chart no driving for approximately one month and while taking narcotics, will be discussed at follow up appointment with surgeon when you will be able to drive no lifting more than 10 pounds for 10 weeks please call with any questions or concerns females: please wear bra to reduce pulling on incision, avoid rubbing on lower edge **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** followup instructions: you are scheduled for the following appointments surgeon: dr. on at 1:15pm cardiologist: dr. on at 10 am for echo and then appt with dr at 11 am wound check in , on at 10am primary care dr. on at 10:00am **please call cardiac surgery office with any questions or concerns . answering service will contact on call person during off hours** labs: pt/inr for coumadin ?????? indication: mechanical valve goal inr 2.5-3.0 first draw wednesday results to cardiac surgery office phone until set up with dr office procedure: extracorporeal circulation auxiliary to open heart surgery open and other replacement of aortic valve diagnoses: congestive heart failure, unspecified unspecified essential hypertension other complications due to heart valve prosthesis aortic valve disorders other and unspecified hyperlipidemia chronic systolic heart failure surgical operation with implant of artificial internal device causing abnormal patient reaction, or later complication,without mention of misadventure at time of operation asymptomatic human immunodeficiency virus [hiv] infection status 

Answer: The patient is high likely exposed to