Active or latent infection requiring resolution / prophylaxis before initiating ABVD / A+...

Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.

ID	`RF-CHL-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-CHL`
Sources	`SRC-ESMO-HODGKIN-2024` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating ABVD / A+AVD / BEACOPP in classical Hodgkin lymphoma: HBsAg-positive (HBV reactivation risk on prolonged steroid-free chemo is moderate, but high if BEACOPP with prednisone), anti-HBc-positive (occult HBV), HCV-RNA-positive, HIV-positive (HIV-Hodgkin association, often EBV-driven), or active TB.
Clinical direction	hold
Category	infection-screening

Trigger Logic

{
  "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
    }
  ],
  "type": "lab_value"
}

Notes

HBsAg+ → entecavir or tenofovir prophylaxis throughout chemo + 6-12 mo post (particularly important if escalated BEACOPP — prolonged steroid + alkylator load). HIV+ cHL: continue ART, full-dose ABVD (or A+AVD if fit) — outcomes approach HIV-negative cHL; avoid BEACOPP in HIV (excess toxicity). Active TB: full anti-TB course before chemo when feasible. PJP prophylaxis (TMP-SMX) not routine on ABVD but recommended on BEACOPP-escalated. EBV detectable ~30-40% cHL — informative not actionable for treatment selection.

Used By

Algorithms

ALGO-CHL-1L - ALGO-CHL-1L