<prompt> Please answer with one of the option in the bracket. Write reasoning in between . Write answer in between .Q:A 43-year-old man with HIV infection comes to the physician because of a 2-week history of progressive diarrhea and a 3-kg 6.6-lb weight loss. During this period, he has had 34 episodes of watery stools daily, with multiple instances of blood in the stool. He is currently receiving antiretroviral therapy with zidovudine, lamivudine, and dolutegravir. Physical examination shows pallor and dry mucous membranes. A colonoscopy shows multiple linear ulcers. Polymerase chain reaction of a stool sample is positive for cytomegalovirus. Treatment with valganciclovir is begun. Adding this drug to his current medication regimen puts this patient at greatest risk for which of the following adverse effects?? A: Hyperglycemia, B: Abnormal dreams, C: Hepatic steatosis, D: Pancytopenia, E: Orthostatic dysregulation,  <response>: This is a clinical vignette about a 43-year-old HIV-positive man with diarrhea, weight loss, and bloody stools. He is on antiretroviral therapy and has been diagnosed with cytomegalovirus colitis based on colonoscopy findings and positive PCR. He has started treatment with valganciclovir. The question asks what adverse effect he is at greatest risk for from adding valganciclovir to his current regimen. The choices given are hyperglycemia, abnormal dreams, hepatic steatosis, pancytopenia, and orthostatic dysregulation. Of these, pancytopenia is a known adverse effect of valganciclovir, especially in combination with other antiretrovirals like zidovudine, which can also cause bone marrow suppression. The other answers do not reflect known major adverse effects of valganciclovir.D: Pancytopenia 