A 61-year-old homeless man with a history of HIV, hepatitis C, schizophrenia, and substance abuse

A 61-year-old homeless man with a history of HIV, hepatitis C, schizophrenia, and substance abuse presents to the emergency department with hematemesis. He denies any abdominal or back pain. He has been on antiretroviral treatment for 20 years and reports good adherence. His records indicate that his last several CD4 counts have been stable between 300 and 350 cells/mm3 and his HIV viral load has been undetectable. As part of the assessment, the physician conducts an abdominal examination and finds that his spleen is palpable about 2 cm below the left costal margin. What is the most likely cause of your physical examination findings? Portal hypertension. AIDS. Sickle cell anemia. Splenic infarct. Hematologic malignancy.

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