Infection active ou latente nécessitant une résolution / prophylaxie avant d'amorcer une...

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ID	`RF-ENDOMETRIAL-INFECTION-SCREENING`
Type	Signal d’alerte
État	reviewed 2026-04-27 \| pending_clinical_signoff
Maladies	`DIS-ENDOMETRIAL`
Sources	`SRC-ESMO-ENDOMETRIAL-2022` `SRC-NCCN-UTERINE-2025`

Origine du drapeau rouge

Définition	Active or latent infection requiring resolution / prophylaxis before initiating cytotoxic chemo (carbo+pacli, doxorubicin-containing for carcinosarcoma) or ICI (pembro / dostarlimab) in endometrial cancer: HBsAg-positive (HBV reactivation risk on cytotoxic chemo and on ICI; doxorubicin notable for HBV reactivation in non-lymphoma settings), anti-HBc-positive (occult HBV), HIV-positive, active TB.
Direction clinique	en attente
Catégorie	dépistage des infections

Logique de déclenchement

{
  "any_of": [
    {
      "finding": "hbsag",
      "value": "positive"
    },
    {
      "finding": "anti_hbc_total",
      "value": "positive"
    },
    {
      "finding": "hcv_rna",
      "value": "positive"
    },
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "active_tb",
      "value": true
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

HBV reactivation on doxorubicin-containing carcinosarcoma regimens (ifosfamide-paclitaxel, carbo-paclitaxel-doxorubicin) is documented; HBsAg+ → mandatory entecavir or tenofovir prophylaxis from before first cycle through ≥6 months post-last-chemo (ASCO HBV guidance). ICI (pembro / dostarlimab): chronic HBV not absolute contraindication but suppress viral load with antiviral first; HIV well controlled on ART can receive ICI safely. Direction "hold" surfaces a workup- prerequisite annotation rather than switching indication.

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