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: no known allergies / adverse drug reactions attending: chief complaint: respiratory distress major surgical or invasive procedure: bipap intubation, extubation () history of present illness: 69 year old male with history of hiv (cd4 116 ), copd (2-4l at home), dvt on coumadin, hypertension, chronic lower back , osteoporosis who presents with respiratory distress. the patient had been recently admitted 5/13-16/ for copd exacerbation and treated with nebs, azithromycin, prednisone (slow taper). the patient presented to the ed on for dyspnea but left ama before admission. he was sent to the ed on but left ama again, with prednisone and azithromycin prescriptions which he never filled. he had seen dr. in pulmonary clinic yesterday and had been non-compliant with prednisone taper. he endorsed "exhaustion" at the appointment but was stable 93% on 3.5l nasal cannula. the patient had also been at clinic with dr. prior to pulmonary appointment. . the patient re-presented to the ed today with worsening dyspnea and was brought in by ems in respiratory distress (enroute co2 50). he responded to nebulizers enroute and arrived looking very uncomfortable, using accessory muscles. he was tight on pulmonary exam with minimal breath sounds and speaking few word sentences. the patient was started on bipap (50%, psv 15, peep 5), which he tolerated well. he was briefly weaned off to 4l nc but decompensated, tripoding despite methylprednisolone 125mg iv x1, azithromycin 500mg, more nebulizers and ativan 2mg iv. . ros: patient denies fevers/chills, nausea/vomiting, myalgias, changes in bowel movement or urination. past medical history: * hiv (diagnosed , s/p multiple haart regimens, no history of opportunistic infections, cd4 nadir 116) * copd (chornic o2 therapy at home 2-4l prn, intubated recently at and was dnr/dni in the past) * dvt (left lower extremity, ; still on coumadin therapy - for sedentary lifestyle) * h/o rectal bleeding * chronic lower back pain s/p numerous back surgeries * hypertension * basilar aneurysm s/p clipping by dr. () * h/o substance abuse with cocaine * anemia of chronic disease * osteoporosis * s/p ileocecetomy for ?cancer. sbo in with lysis of adhesions social history: denies alcohol, smoking or illicit drugs (since ). previous 80 pack year smoker. lives alone, uses wheelchair. family history: hypertension and throat cancer in brother (smoker) physical exam: temp: 97.0 bp: 132/80 hr: 89 rr: 18 o2sat 100% on bipap (15/5, 50%) gen: pleasant, comfortable, nad, mildly anorexic heent: perrl, eomi, anicteric, mmm, resp: cta b/l with good air movement throughout, ?prolonged expiratory phase, barrel chested with increased ap diameter cv: regular rate, rhythm; s1 and s2 wnl, no murmurs/gallops/rubs abd: nontender, nondistended, +bs, soft ext: no cyanosis/ecchymosis, + bilateral lower extremity edema (symmetric) skin: no rashes/no jaundice/no splinters neuro: aaox3. cn 2-12 intact. strength and sensation intact. . discharge exam: no vitals (cmo) gen: cachectic in nad, no jaundice, no palor heent: ncat perrl mmms op clear neck: no jvp elevation supple pulm: very poor air movement wheezes throughout; no rhonci no crackles cv: rrr nml s1 s2 no m/r/g ab: +bs ntnd ext: no edema neuro: grossly intact ao x 3 responding appropriately to questions pertinent results: 06:47pm o2-100 po2-244* pco2-53* ph-7.44 total co2-37* base xs-10 aado2-426 req o2-73 06:13pm lactate-1.9 . cxr : patchy opacity in left lung base, similar to the prior study, which remains concerning for infection. severe emphysema. . cxr : an endotracheal tube lies at the level of the clavicular heads, appropriately positioned. a nasogastric tube courses into the stomach. severe emphysema is noted. the cardiomediastinal silhouette is stable. there are small bilateral pleural effusions. the left lower lobe opacity has mildly improved and reflects resolving infection. no new focal consolidation is appreciated. . discharge labs: none brief hospital course: 69 year old male with history of hiv (cd4 116 ), copd (2-4l at home), dvt on coumadin, hypertension, chronic lower back , osteoporosis who presents with respiratory distress. . # respiratory distress: most likely due to ongoing copd exacerbation. trigger unclear given lack of pneumonia on initial cxr, no fevers/chills, productive cough. patient has been non-compliant with medications, however, since discharge; this includes prednisone and antibiotics. ?compliance with nebulizers and has supplemental o2 at home. the patient has had cta recently to rule out pulmonary emboli given ongoing dyspnea despite therapy. he was treated with azithromycin for 5 days and methylprednisolone. he intermittently required bipap. a plan was made to use bipap at night once the patient was able to leave the icu. however on the morning of patient was anxious, tachypneic and desatted and required intubation. the patient was extubated on . he did well overnight but subsequently had further respiratory distress and his steroids were increased to full burst. he ultimately decided to be dnr/dni and came to the understanding that he wasn't going to get better; the patient decided to become cmo and was discharged to home hospice after discussing with palliative care in-house. - continue long steroid taper at home (prednisone 60mg x 7 days, 40mg x 7 days, 20 mg x7 days, 10mg x 7 days, off) - continue supplemental oxygen, albuterol and ipratropium nebs - continue ms contin and morphine liquid prn for air hunger, shortness of breath - continue lorazepam prn for air hunger, shortness of breath, anxiety . # hiv: down trending cd4 count, ?due to acute illness. continued abacavir, lamivudine, fosamprenavir, and atazanavir. continued bactrim ss daily. patient does have history of bactrim needing to be held in for bone marrow suppression. the need for ongoing haart medication and pcp prophylaxis was discussed with the patient. it was felt that he likely will not succumb to hiv/aids or an opportunistic infection before he succumbs to his end-stage copd. however, taking these medications are not a hardship for the patient and he would prefer not to risk increasing hiv viral load and chance of opportunistic infection, especially in the setting of ongoing steroids. - the patient will be discharged home on hospice with continuation of his haart medications and bactrim pcp . . # dvt: leni the day prior to admission as outpatient was negative for dvt. patient has been therapeutic and followed by here at . he missed several doses of coumadin in the settting of being on bipap and developed a subtherapeutic inr. he was bridged with lovenox. anticoagulation held for concern for gib but coumadin was resumed when hct was stable for 24 hrs. upon discharge home with hospice, however, anticoagulation was discussed with the patient. as he had a dvt in and ultimately completed treatment but was continued given his sedentary/immobile nature, the indication for ongoing anticoagulation and risk of dvt/pe is not high. - given this information, the patient chose to be discharged off of coumadin. his primary care provider and the anticoagulation nurses were informed of his decision, and the fact that he no longer needs inr checks. . #gib: patient noted to have guaic positive stool. t+s sent, ppi started, picc placed, transfused 1 unit of blood but did not bump appropriately, so given 2nd unit. hct then increased appropriately and remained stable. - ppi was stopped given the absence of frank melena on discharge and to minimize medications for hospice. . # multifocal atrial tachycardia: seen in the ed during patient's hospitalization . patient was started on diltiazem in this setting but did not have mat last admission either. the patient can continue on home diltiazem on discharge to prevent discomfort from breakthrough tachycardia. . # anemia: slightly lower than baseline hct close to 30. normocytic and previously thought due to chronic disease. haart medications may be contributing to marrow suppression. in addition, pt noted to have guaic positive stools which are discussed above. . # hypertension: stable, mildly hypertensive, continued diltiazem and doxazosin. -- doxazosin was stopped on discharge for hospice to streamline medications. . # osteoporosis: on calcium and vitamin d. - these medications were stopped on discharge to streamline medications. . # gerd: admitted on famotidine. stable, started on ppi as above while intubated as famotidine can also interact with hiv medications; also in setting of guaiac positive stools per above. - famotidine was stopped on discharge to streamline medications. . # other transitional issues: - continue home o2 as prescribed - oral suction as prescribed - maintain picc with appropriate heparin flushes as a provision for morphine infusion if patient's air hunger is refractory to po morphine elixir and he requires iv morphine medications on admission: * atazanavir 400mg daily * fosamprenavir 1400mg twice daily * aspirin 325mg daily * abacavir 600mg daily * lamivudine 300mg daily * albuterol nebs every 2 hours prn sob, wheezing * ipratropium nebs every 6 hours * warfarin 3mg daily six times weekly, 2mg on friday * doxazosin 2mg qhs * diltiazem 30mg three times daily * famotidine 20mg daily * bactrim 400-80 daily discharge medications: 1. atazanavir 200 mg capsule sig: two (2) capsule po daily (daily). 2. diltiazem hcl 30 mg tablet sig: one (1) tablet po tid (3 times a day). 3. sulfamethoxazole-trimethoprim 400-80 mg tablet sig: one (1) tablet po daily (daily). 4. docusate sodium 50 mg/5 ml liquid sig: ten (10) ml po bid (2 times a day) as needed for constipation. 5. lamivudine 150 mg tablet sig: two (2) tablet po daily (daily). 6. abacavir 300 mg tablet sig: two (2) tablet po daily (daily). 7. fosamprenavir 700 mg tablet sig: two (2) tablet po q12h (every 12 hours). 8. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation every four (4) hours: standing. disp:*30 nebs* refills:*2* 9. albuterol sulfate 2.5 mg /3 ml (0.083 %) solution for nebulization sig: one (1) neb inhalation q2h (every 2 hours) as needed for wheezing, shortness of breath. 10. ipratropium bromide 0.02 % solution sig: one (1) neb inhalation q6h (every 6 hours): standing. disp:*30 nebs* refills:*2* 11. prednisone 20 mg tablet sig: three (3) tablet po daily (daily): x7days, 2 tablets daily x7d, 1 tab daily x 7d, half tab daily x 7d, then off. disp:*46 tablet(s)* refills:*0* 12. lorazepam 0.5 mg tablet sig: 1-2 tablets po every four (4) hours as needed for shortness of breath, air hungry, anxiety. disp:*60 tablet(s)* refills:*0* 13. ms contin 15 mg tablet extended release sig: two (2) tablet extended release po every eight (8) hours. disp:*90 tablet extended release(s)* refills:*2* 14. morphine concentrate 100 mg/5 ml (20 mg/ml) solution sig: ten (10) mg po q2h as needed for shortness of breath, air hunger, pain. disp:*500 ml* refills:*2* 15. supplemental oxygen sig: 1-5 liters once a day: via nasal cannula, titrate to comfort prn. disp:*1 tank* refills:*2* 16. admit to sig: one (1) once a day. disp:*1 unit* refills:*2* 17. maintain picc at home maintain picc at home with hospice for use with morphine infusion if need for sob, air hunger 18. heparin, porcine (pf) 10 unit/ml syringe sig: ten (10) ml intravenous prn (as needed) as needed for line flush. disp:*30 ml(s)* refills:*2* 19. oral suction as needed for secretions 20. supplemental home oxygen oxygen 5-10l as needed discharge disposition: home with service facility: discharge diagnosis: primary: copd exacerbation secondary: hiv, prior dvt on anticoagulation, chronic lower back pain, anemia of chronic disease, osteoporosis discharge condition: mental status: clear and coherent. level of consciousness: alert and interactive. activity status: out of bed with assistance to chair or wheelchair. discharge instructions: you were admitted with difficulty breathing. you were found to be having a copd exacerbation. you were treated with steroids (oral and intravenous), antibiotics, nebulizers. you were also put on a breathing machine called bipap to make it easier for you to breath. with your very sick lungs, you did become very tired at one point, and were intubated to use a machine to help you breath. once you were extubated, we discussed your prognosis and the severity of your condition with you. you made the decision to change your code status to do not resuscitate/do not intubate. the goals of your medical care was made for comfort. . you are being discharged home with hospice, who will oversee your care going forward and address all of your symptoms with the goal of making you comfortable. . it is important that you continue to take your medications as directed. we made the following changes to your medications during this admission: --> stop coumadin and inr checks --> stop aspirin --> stop doxazosin --> stop famotidine --> continue prednisone 60mg daily x 1 weeks, with a slow taper --> start lorazepam as needed for shortness of breath, air hunger, anxiety --> start ms contin 30mg three times daily for air hunger --> start morphine liquid 5-10ml every 2 hours as needed for air hunger --> start prednisone and take as directed according to the prescribed taper --> continue albuterol nebs every 4 hours standing --> continue albuterol nebs every 2 hours as needed for shortness of breath, wheeze --> continue ipratropium nebs every 6 hours standing . contact your hospice organization if you need help controlling your symtoms. followup instructions: please feel free to contact your hospice nurses and physicians with any questions or concerns. . also feel free to contact dr. , your new primary care doctor, at at . . department: when: wednesday at 10:00 am with: building: sc clinical ctr campus: east best parking: garage department: when: wednesday at 12:00 pm with: building: sc clinical ctr campus: east best parking: garage procedure: continuous invasive mechanical ventilation for less than 96 consecutive hours venous catheterization, not elsewhere classified insertion of endotracheal tube enteral infusion of concentrated nutritional substances diagnoses: other chronic pain anemia, unspecified esophageal reflux unspecified essential hypertension obstructive chronic bronchitis with (acute) exacerbation human immunodeficiency virus [hiv] disease acute respiratory failure osteoporosis, unspecified long-term (current) use of anticoagulants personal history of venous thrombosis and embolism nonspecific abnormal findings in stool contents do not resuscitate status hyperosmolality and/or hypernatremia lumbago 

Answer: The patient is high likely exposed to