Active or latent infection requiring resolution / prophylaxis before initiating ICI (anti...

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

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

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating ICI (anti-PD1 ± anti-CTLA4) or BRAFi+MEKi in advanced melanoma: HBsAg+ or anti-HBc+ (HBV reactivation risk on ICI; baseline HBV DNA + antiviral prophylaxis if reactivation history), HCV-RNA+ (DAA coordination; ICI generally safe with controlled HCV), HIV-positive (ICI safe with virologic suppression on ART; CHECKMATE HIV cohorts confirm efficacy), active TB, or active uncontrolled infection.
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
    },
    {
      "finding": "active_uncontrolled_infection",
      "value": true
    }
  ],
  "type": "composite"
}

Notes

ICI + chronic HBV: HBsAg+ → entecavir or tenofovir prophylaxis from before first ICI dose through ≥6 months post-last-dose; monitor HBV DNA q3mo. Anti-HBc+ alone (resolved HBV): monitor HBV DNA + ALT q3mo, prophylaxis only if reactivation. HIV+ with CD4 >100 + viral load suppressed on ART: ICI active and tolerable (CHECKMATE-358 HIV cohort). Active TB: complete intensive-phase anti-TB before initiating ICI to avoid masking IRIS / TB worsening on immune reconstitution. Direction "hold" surfaces a workup-prerequisite annotation rather than switching indication.

Used By

No reverse references found in the YAML corpus.