Risk of HBV reactivation prior to immunosuppressive / cytotoxic therapy: HBsAg-positive (...

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

ID	`RF-UNIVERSAL-HBV-REACTIVATION-RISK`
Type	Red flag
Status	reviewed 2026-04-25 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-EASL-HCV-2023` `SRC-NCCN-BCELL-2025`

Red Flag Origin

Definition	Risk of HBV reactivation prior to immunosuppressive / cytotoxic therapy: HBsAg-positive (high-risk) OR HBsAg-negative + anti-HBc-positive (occult HBV, intermediate risk). Applies to anti-CD20 (rituximab, obinutuzumab), BTKi, autoSCT, and any high-dose corticosteroid regimen.
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

Mandates entecavir or tenofovir prophylaxis from -7 days through +12 months post-last-anti-CD20 (NCCN B-Cell v2.2025 §HBV-1). Reactivation rate without prophylaxis: 30-50% in HBsAg+, 5-10% in HBsAg-/anti-HBc+ cohorts receiving anti-CD20 (Huang et al. 2014, Seto et al. 2014). Replaces the disease-specific RF-HBV-COINFECTION pattern; that RF is retained for ALGO-HCV-MZL-1L pending the clinical-co-lead decision in docs/plans/archive/rf_wiring_audit_2026-04-25.md.

Used By

Algorithms

ALGO-DLBCL-1L - ALGO-DLBCL-1L

Contraindications

CI-HBV-NO-PROPHYLAXIS - CI-HBV-NO-PROPHYLAXIS

Indications

IND-DLBCL-1L-RCHOP - IND-DLBCL-1L-RCHOP
IND-NMZL-1L-HCV-POSITIVE - IND-NMZL-1L-HCV-POSITIVE

Red flag

RF-B-ALL-INFECTION-SCREENING - HBV/HCV/HIV/CMV serology + latent TB testing mandatory pre-induction; rituximab-containin...
RF-BREAST-INFECTION-SCREENING - HBV/HCV/HIV serology + dental evaluation pre-bisphosphonate/denosumab + DPYD genotyping f...
RF-HBV-COINFECTION - Hepatitis B coinfection: HBsAg positive OR anti-HBc total positive (occult HBV risk). HCV...
RF-HCC-HBV-REACTIVATION-RISK - HBV-positive HCC patient (any HBsAg+ OR anti-HBc+ status). Anti-tumor therapy — especiall...
RF-HGBL-DH-INFECTION-SCREENING - HBV/HCV/HIV serology mandatory pre-rituximab; HIV-associated HGBL-DH gets cART optimizati...
RF-NMZL-INFECTION-SCREENING - HBV/HCV/HIV serology mandatory pre-rituximab; no NMZL-specific infectious driver establis...
RF-NSCLC-INFECTION-SCREENING - Active TB OR latent TB conversion risk — ICI may trigger TB reactivation; pre-treatment I...
RF-PMBCL-INFECTION-SCREENING - Pre-treatment HBV/HCV/HIV serology mandatory before rituximab; HBsAg+ requires antiviral...