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

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

ID	`RF-SALIVARY-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-SALIVARY`
Sources	`SRC-ESMO-SALIVARY` `SRC-NCCN-HEAD-AND-NECK`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating cisplatin-based chemotherapy, trastuzumab, larotrectinib / entrectinib, or bicalutamide for advanced salivary gland carcinoma: HBsAg-positive (HBV reactivation on cytotoxic + targeted), anti-HBc- positive (occult HBV), HIV-positive (ART coordination), 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

Trastuzumab carries HBV reactivation risk (FDA boxed warning class effect for chemoimmunotherapy in HBV-endemic regions). Larotrectinib / entrectinib (CYP3A4 substrates) require ART coordination — avoid ritonavir-boosted PIs. Bicalutamide / LHRH analogs (AR+ SDC) are generally low-risk for HBV reactivation but standard pre-treatment screening still applies. Active TB: complete anti-TB before head-and- neck RT given mucositis + neutropenia overlap. HBsAg+: entecavir / tenofovir prophylaxis. HIV+: PCP prophylaxis if on cytotoxic combination chemotherapy.

Used By

No reverse references found in the YAML corpus.