Chronic immunosuppression ≥1 year — any of: (a) untreated or treated HIV with CD4 nadir <...

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

ID	`RF-UNIVERSAL-IMMUNOCOMPROMISED-CANCER-RISK`
Type	Red flag
Status	reviewed 2026-05-18 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-IDSA-EBV-2019` `SRC-NIH-AIDS-2024`

Red Flag Origin

Definition	Chronic immunosuppression ≥1 year — any of: (a) untreated or treated HIV with CD4 nadir <350 or current detectable viral load, (b) solid-organ-transplant recipient on chronic calcineurin- inhibitor / mTOR / mycophenolate / antimetabolite regimen, (c) hematologic-stem-cell-transplant recipient (allogeneic, chronic GVHD on systemic immunosuppression), (d) autoimmune disease on long-term immunosuppressant (azathioprine, mycophenolate, cyclosporine, methotrexate at autoimmune doses, biologic immunosuppressants — TNF / IL-17 / IL-23 inhibitors, JAK inhibitors), (e) primary / inherited immunodeficiency (CVID, XLA, hyper-IgM, ataxia-telangiectasia, Wiskott-Aldrich, etc.). Aggregate elevated risk per HIV/AIDS Malignancy Branch + IDSA immunocompromised host guidelines + transplant-recipient registry analyses: AIDS-defining cancers (Kaposi sarcoma, non-Hodgkin lymphoma including primary CNS lymph...
Clinical direction	investigate
Category	other

Trigger Logic

{
  "any_of": [
    {
      "finding": "chronic_immunosuppression_ge_1y_documented",
      "value": true
    }
  ],
  "type": "composite_score"
}

Notes

Pre-triage universal RedFlag — chronic immunosuppression ≥1y from any cause (HIV / transplant / autoimmune-on-immunosuppressant / inherited immunodef). risk_category=iatrogenic best captures the dominant adult cohort (transplant + autoimmune-on-biologic) though primary-immunodeficiency cohort would fit `chronic_condition`. Trigger uses NOVEL finding `chronic_immunosuppression_ge_1y_documented: true` deliberately distinct from `hiv_status: positive` (pilot HIV test patient finding) to avoid cross-firing with RF-CHRONIC-HIV-MALIGNANCY-PREVENTION test scenario. Universal Indications anchored to DIS-KAPOSI (AIDS-defining; NOT DIS-DLBCL-NOS which is the HIV pilot target — advisor note). With relevant_diseases=["*"], engine does NOT attach Indication tracks via prevention path (plan.py:297 excludes "*") — universal Indications are documentation / sidecar candidates pending future engine extension. STUB pending two-Clinical-Co-Lead signoff per CHARTER §6.1 dev-mode.

Used By

Indications

IND-UNIVERSAL-IMMUNOCOMPROMISED-PREVENTION-ROUTINE-SCREENING - IND-UNIVERSAL-IMMUNOCOMPROMISED-PREVENTION-ROUTINE-SCREENING
IND-UNIVERSAL-IMMUNOCOMPROMISED-PREVENTION-STRATIFIED-SCREENING - IND-UNIVERSAL-IMMUNOCOMPROMISED-PREVENTION-STRATIFIED-SCREENING