HBV-positive HCC patient (any HBsAg+ OR anti-HBc+ status). Anti-tumor therapy — especiall...

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

ID	`RF-HCC-HBV-REACTIVATION-RISK`
Type	Red flag
Status	reviewed 2026-04-26 \| pending_clinical_signoff
Diseases	`DIS-HCC`
Sources	`SRC-AASLD-HCC-2023` `SRC-NCCN-HCC-2025`

Red Flag Origin

Definition	HBV-positive HCC patient (any HBsAg+ OR anti-HBc+ status). Anti-tumor therapy — especially anti-VEGF (bev) and ICI — can precipitate HBV reactivation with ALT flare and hepatic decompensation in unprophylaxed patients. Mandates entecavir/TDF prophylaxis throughout treatment + ≥12 mo post.
Clinical direction	hold
Category	infection-screening

Trigger Logic

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

Notes

HCC-specific HBV gate — separate from RF-UNIVERSAL-HBV-REACTIVATION-RISK because HCC patients have higher baseline viremia + cirrhotic substrate. Entecavir or tenofovir disoproxil/alafenamide acceptable; concurrent with HCV-DAA pathway acceptable when both viruses present.

Used By

Indications

IND-HCC-SYSTEMIC-1L-ATEZO-BEV - IND-HCC-SYSTEMIC-1L-ATEZO-BEV