Concurrent chronic HCV + HBV coinfection (HCV-RNA detectable ≥6 months AND HBsAg positive...

Детермінований перегляд YAML-сутності з джерельної бази. Клінічний авторитет лишається за вказаними source ID та статусом клінічного sign-off.

ID	`RF-CHRONIC-HCV-HBV-COINFECTION-PREVENTION`
Тип	Тривожна ознака
Статус	переглянуто 2026-05-18 \| очікує клінічного підпису
Хвороби	`DIS-HCC`
Джерела	`SRC-AASLD-HBV-2024` `SRC-AASLD-HCC-2023` `SRC-AASLD-IDSA-HCV-2023` `SRC-EASL-HBV-2025` `SRC-EASL-HCV-2023`

Походження тривожної ознаки

Визначення	Concurrent chronic HCV + HBV coinfection (HCV-RNA detectable ≥6 months AND HBsAg positive ≥6 months) in an individual without a current HCC, fulminant hepatitis, or HCV/HBV-associated lymphoma diagnosis. Coinfection carries higher HCC incidence and a real risk of HBV reactivation / fulminant hepatitis when HCV is cured by DAA monotherapy (HCV historically suppressed HBV replication; DAA cure lifts that suppression). IARC Group 1 carcinogens (HCV + HBV both) — established etiological drivers, synergistic for HCC. Combination pathway: DAA (e.g. sofosbuvir/velpatasvir) for HCV cure plus concurrent nucleos(t)ide analog (entecavir or tenofovir TDF / TAF) for HBV suppression; HCC surveillance more intensive than either mono-infection (US + AFP every 4-6 months per AASLD-modified protocol). Prevention-persona RedFlag (§20 ratification 2026-05-18).
Клінічний напрям	investigate
Категорія	other

Логіка спрацьовування

{
  "all_of": [
    {
      "finding": "hcv_rna",
      "value": "detectable"
    },
    {
      "finding": "hbsag",
      "value": "positive"
    }
  ],
  "type": "lab_value"
}

Нотатки

Prevention-persona RedFlag for HCV + HBV coinfection cancer prevention. Higher severity (critical) than either mono-infection RF — coinfection carries documented synergistic HCC risk AND DAA-cure-induced HBV reactivation risk that requires combination antiviral. Engine routes to PreventionPlan recommending concurrent DAA + nucleos(t)ide analog + intensified HCC surveillance (US + AFP q4-6mo, more frequent than the q6mo cadence for either mono-infection). STUB pending Co-Lead review. Cancer scope: anchored to DIS-HCC. NHL prevention (HCV-driven) continues to be a secondary benefit; tracked via prose in the combined-antiviral indication rationale. Distinct from RF-CHRONIC-HCV-NHL-PREVENTION-OPPORTUNITY and RF-CHRONIC-HBV-MALIGNANCY-PREVENTION (individual mono-infection RFs). When coinfection trigger fires, this RF takes precedence over the two individual RFs (higher priority).

Де використовується

Indications

IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-COMBINATION-ANTIVIRAL - IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-COMBINATION-ANTIVIRAL
IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-OBSERVATION - IND-CHRONIC-HCV-HBV-COINFECTION-PREVENTION-OBSERVATION