From the Guidelines
This pattern of hepatitis B serology, with a positive core antibody and negative surface antibody and surface antigen, indicates a past hepatitis B infection with resolution but without development of protective immunity. According to the most recent and highest quality study 1, this serologic pattern could represent several scenarios: a resolved infection where surface antibodies have waned over time, a "window period" of acute infection (though unlikely without symptoms or elevated liver enzymes), or a false positive core antibody test. In rare cases, it might indicate occult hepatitis B infection with low-level viral replication.
Key Considerations
- No immediate treatment is needed, but the patient should be monitored with repeat testing in 3-6 months to confirm this interpretation.
- Additional testing that may be helpful includes hepatitis B viral DNA to rule out occult infection, and IgM anti-HBc to distinguish between recent and remote infection.
- Patients with this serologic pattern should be counseled about potential viral reactivation if they become immunosuppressed in the future, as noted in 1 and 1.
- They should also be screened for other viral hepatitis infections like hepatitis C, as co-infection is common, as mentioned in 1 and 1.
Management and Prevention
- The risk of HBV reactivation for patients who are HBsAg negative, HBcAb positive varies widely based on the virological profile, disease, and immunosuppressive regimen, as discussed in 1 and 1.
- Serum HBV DNA testing before the start of therapy may help define their risk of reactivation, as recommended in 1.
- If viremic, they may receive similar prophylaxis as patients who are HBsAg positive, as suggested in 1.
From the Research
Interpretation of Hepatitis B Test Results
- A hepatitis B core antibody (anti-HBc) positive result indicates that the individual has been infected with hepatitis B virus (HBV) at some point in their life 2.
- The presence of hepatitis B surface antibody (anti-HBs) and the absence of hepatitis B surface antigen (HBsAg) suggest that the individual has cleared the virus and is no longer infectious 3, 2.
- The anti-HBs antibody is recognized as a protective immune marker, indicating that the individual has developed immunity to HBV either through infection and clearance or through vaccination 3.
- The combination of anti-HBc positivity and anti-HBs positivity, with HBsAg nonreactive, may indicate a past infection that has been cleared, and the individual is no longer at risk of transmitting the virus 2, 4.
Clinical Implications
- The detection of anti-HBc and anti-HBs antibodies, in the absence of HBsAg, is important for the clinical classification and epidemiological surveillance of HBV infection 2.
- The level of anti-HBc antibody may be used as a predictor of HBsAg clearance in patients with chronic hepatitis B, particularly those receiving pegylated interferon-alfa therapy 4.
- A lower level of anti-HBc antibody at week 12 of treatment may indicate a higher likelihood of HBsAg clearance and seroconversion 4.