HARGE SUMMARY for patient: Smart, Joann
ADMITTING AND DISCHARGE DIAGNOSIS:
1. Pneumoncystis pneumonia.
2. Human immunodeficiency virus infection.
3. Wasting
SOCIAL HISTORY: Patient's husband is deceased from AIDS 1 year ago with progressive multifocal leukoencephalopathy and
sarcoma. She denies any history of intravenous drug use or transfusion and identifies three lifetime sexual partners.
PAST MEDICAL HISTORY: Patient's past medical history is significant for HIV and several episodes of diarrhea, sinusitis, thrush
vaginal candidiasis. She gave a history of a 10-pound weight loss. The chest e-ray showed diffuse lower lobe infiltrates, and sh
diagnosed with presumptive Pneumocystis pneumonia and placed on Bactrim. She was admitted for a bronchoscopy with alve
lavage to confirm the diagnosis.
PROCEDURE: The antiretroviral treatment was reinitiated, and she was counseled as to the need to strictly adhere to her thera
regimen.
DISCHARGE INSTRUCTIONS: Complete medication regimen. Patient discharged to the care of Dr. Amid Shaheen.

The patient denies use of intravenous drugs but still is diagnosed with HIV. What is the most likely way she acquired HIV?