Concurrent HIV + HBV coinfection (HIV-positive AND HBsAg positive ≥6 months OR HBV-DNA de...

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

ID	`RF-CHRONIC-HIV-HBV-COINFECTION-PREVENTION`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HBV-2024` `SRC-AASLD-HCC-2023` `SRC-EASL-HBV-2025` `SRC-NIH-AIDS-2024`

Red Flag Origin

Definition	Concurrent HIV + HBV coinfection (HIV-positive AND HBsAg positive ≥6 months OR HBV-DNA detectable ≥6 months) in an individual without a current HCC or AIDS-defining malignancy diagnosis. IARC Group 1 carcinogens (HBV, HIV-indirect immunosuppression) — coinfection carries elevated HCC risk and accelerated liver fibrosis vs HBV mono-infection. The ART regimen for HIV+/HBV+ MUST be tenofovir-based (TDF or TAF, paired with FTC or 3TC) — tenofovir has dual activity against HIV and HBV; entecavir is NOT active against HIV and monotherapy in a coinfected patient drives HIV resistance. Surveillance: AASLD HCC US + AFP every 6 months. Prevention-persona RedFlag (§20 ratification 2026-05-18).
Clinical direction	investigate
Category	other

Trigger Logic

{
  "all_of": [
    {
      "finding": "hiv_status",
      "value": "positive"
    },
    {
      "finding": "hbsag",
      "value": "positive"
    }
  ],
  "type": "lab_value"
}

Notes

Prevention-persona RedFlag for HIV + HBV coinfection cancer prevention. Higher severity (critical) than mono-infection HBV RF — coinfection carries documented accelerated-fibrosis + elevated HCC risk AND a hard constraint on antiviral selection (tenofovir-based ART mandatory; entecavir monotherapy contraindicated). Engine routes to PreventionPlan recommending tenofovir-based ART (covers both viruses simultaneously) + AASLD HCC surveillance q6mo. STUB pending Co-Lead review. Cancer scope: anchored to DIS-HCC. HIV-driven AIDS-defining malignancies (Kaposi sarcoma via HHV-8 reactivation, NHL, cervical) are covered separately via RF-CHRONIC-HIV-MALIGNANCY-PREVENTION and RF-CHRONIC-HHV8-MALIGNANCY-PREVENTION. Distinct from RF-CHRONIC-HBV-MALIGNANCY-PREVENTION and RF-CHRONIC-HIV-MALIGNANCY-PREVENTION (individual mono-infection RFs). When coinfection trigger fires, this RF takes precedence (higher priority) and the indication enforces tenofovir-based ART selection.

Used By

Indications

IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-OBSERVATION - IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-OBSERVATION
IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-TENOFOVIR-ART - IND-CHRONIC-HIV-HBV-COINFECTION-PREVENTION-TENOFOVIR-ART