Active or latent infection requiring resolution / prophylaxis before initiating carbo+pac...

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

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

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating carbo+pacli ± bevacizumab and PARPi maintenance in advanced ovarian: HBsAg+ or anti-HBc+ (HBV reactivation on cytotoxic chemo; bevacizumab adds GI / wound-healing complications during reactivation hepatitis), HCV-RNA+, HIV+, active TB, active uncontrolled infection.
Clinical direction	hold
Category	infection-screening
Shifts algorithm	ALGO-OVARIAN-ADVANCED-1L

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

HBsAg+ → entecavir or tenofovir from before first cycle through ≥6 months post-last-chemo / PARPi (PARPi maintenance can be 2-3 years in BRCA+ — extend prophylaxis duration). Bevacizumab during unrecognized HBV reactivation can cause hepatic decompensation and worsen GI mucosal-healing complications (perforation risk). HIV+ with stable ART can receive standard regimens. Active TB: complete intensive-phase anti-TB before initiating chemo. Direction "hold" surfaces a workup-prerequisite annotation rather than switching indication.

Used By

Algorithms

ALGO-OVARIAN-ADVANCED-1L - ALGO-OVARIAN-ADVANCED-1L