Active or latent infection requiring resolution / prophylaxis before initiating long-dura...

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

ID	`RF-THYROID-PAPILLARY-INFECTION-SCREENING`
Type	Red flag
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	`DIS-THYROID-PAPILLARY`
Sources	`SRC-ATA-THYROID-2015` `SRC-NCCN-THYROID-2025`

Red Flag Origin

Definition	Active or latent infection requiring resolution / prophylaxis before initiating long-duration lenvatinib / sorafenib multikinase or selective TKI (selpercatinib / larotrectinib / dabrafenib + trametinib) for RAI-refractory PTC: HBsAg-positive (HBV reactivation reported on TKI-class chronic exposure), anti-HBc-positive (occult HBV), 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

RAI-refractory PTC TKI therapy is multi-year (median PFS 18 mo on lenvatinib SELECT; >25 mo on selpercatinib LIBRETTO) — chronic exposure raises HBV reactivation risk. Standard practice: HBsAg + anti-HBc + anti-HBs serology pre-TKI; entecavir / tenofovir for HBsAg+. HIV+: lenvatinib / sorafenib / selpercatinib / dabrafenib / trametinib are all CYP3A4 substrates — coordinate ART to avoid CYP3A4 inhibitors (ritonavir-boosted PIs). Active TB: rifampin (CYP3A4 inducer) lowers TKI exposure significantly — prefer rifabutin if anti-TB needed concurrently.

Used By

No reverse references found in the YAML corpus.