Active or latent infection requiring resolution / prophylaxis before initiating imatinib...

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

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

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating imatinib / sunitinib / regorafenib / avapritinib for GIST: HBsAg-positive (HBV reactivation reported on TKI-class therapy), anti-HBc-positive (occult HBV — risk on long-duration TKI), HIV-positive (ART coordination, CYP3A4 interactions), or active TB.
Clinical direction	hold
Category	infection-screening

Trigger Logic

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

Notes

HBV reactivation case reports on imatinib (Lok et al; Ikeda et al) prompted FDA label update for monitoring. Standard practice: HBsAg + anti-HBc screening pre-imatinib; if HBsAg+ — entecavir / tenofovir prophylaxis throughout TKI duration (often >3 yr in adjuvant or life- long in metastatic). HIV+: avoid ritonavir-boosted PIs with imatinib / sunitinib (CYP3A4); coordinate ART regimen with infectious disease. Active TB: complete anti-TB before initiating (less urgent than for cytotoxic chemo but still preferred).

Used By

Indications

IND-GIST-4L-RIPRETINIB - IND-GIST-4L-RIPRETINIB