What is the most likely diagnosis for a 36-year-old HIV-positive man with jaundice and elevated liver enzymes after unprotected anal sex?

The most likely diagnosis for the patient described is acute hepatitis C. This conclusion is supported by the patient's risk factors and symptoms. Being HIV-positive significantly increases the likelihood of co-infections, particularly with viral hepatitis. Jaundice, along with elevated liver enzymes, indicates hepatic inflammation, which is characteristic of viral hepatitis.

Acute hepatitis C often presents with these symptoms following potential exposure through high-risk behaviors such as unprotected anal intercourse, where the virus can be transmitted through blood or secretions if there are any mucosal breaches. The timeframe of developing symptoms after exposure aligns with typical acute hepatitis presentations.

While other conditions like acute hepatitis D, CMV infection, and syphilis could be considered based on the patient's background, they are less likely in this scenario. Acute hepatitis D can only occur in individuals who are already infected with hepatitis B, and there is no indication of hepatitis B infection in this case. CMV infection can indeed cause liver issues in immunocompromised individuals, but the specific combination of jaundice, elevated liver enzymes, and the history of potential exposure strongly points toward acute hepatitis C as the most plausible diagnosis. Similarly, syphilis, although a sexually transmitted infection, typically does not cause jaundice or liver enzyme elevation in such