From the Guidelines
A non-reactive Hepatitis B core antibody result indicates that an individual has likely never been infected with the Hepatitis B virus and does not have immunity from past infection, suggesting susceptibility to Hepatitis B infection. This interpretation is based on the recommendations of the Advisory Committee on Immunization Practices, as outlined in the 2018 study 1. According to the study, a negative result for both HBsAg and total anti-HBc, with no detectable HBV DNA, indicates that an individual has never been infected with Hepatitis B.
To determine complete immunity status, additional testing is necessary, particularly for Hepatitis B surface antibody (anti-HBs), which indicates immunity either from vaccination or resolved infection. The presence of anti-HBs is generally indicative of immunity to HBV infection, as noted in the study 1. If both anti-HBc and anti-HBs are negative, the individual has no immunity and should consider vaccination with the standard Hepatitis B vaccine series.
Some key points to consider:
- A non-reactive anti-HBc result does not necessarily rule out the possibility of a false-negative result or a very early infection, as the study notes that some individuals may have isolated anti-HBc positivity due to various reasons, including waning anti-HBs levels after recovery from natural infection or chronic infection with undetectable HBsAg 1.
- Vaccination is especially important for those at higher risk of exposure, including healthcare workers, people who inject drugs, men who have sex with men, and travelers to regions with high Hepatitis B prevalence.
- The Hepatitis B virus can cause both acute and chronic disease, so establishing immunity through vaccination is an effective preventive measure for those without natural immunity, as emphasized in the study 1.
From the Research
Hepatitis B Core Antibody and Immunity
A non-reactive Hepatitis B (Hep B) core antibody result indicates that the individual does not have detectable antibodies against the Hepatitis B core antigen. This can occur in several situations:
- The individual has never been infected with Hepatitis B and has not been vaccinated 2.
- The individual has been vaccinated against Hepatitis B, but the vaccine did not induce a detectable antibody response 2.
- The individual has been infected with Hepatitis B, but the infection was cleared and no antibodies were produced 3.
- The individual has a false negative result due to limitations of the assay used 4.
Interpretation of Non-Reactive Results
A non-reactive Hepatitis B core antibody result does not necessarily mean that the individual is not immune to Hepatitis B. Other factors, such as the presence of antibodies against the Hepatitis B surface antigen (anti-HBs) or the individual's immune response to vaccination, should also be considered 3, 5.
- Some individuals with non-reactive core antibody results may still have immunity to Hepatitis B due to the presence of anti-HBs antibodies 3.
- Vaccination against Hepatitis B can induce an immune response in individuals with non-reactive core antibody results, indicating that they may still be protected against the virus 3, 5.
Limitations of Assays
The sensitivity and specificity of assays used to detect Hepatitis B core antibodies can vary, and false negative results can occur 4.
- More sensitive assays, such as immune precipitation with labelled HBV core antigen, may be able to detect antibodies in individuals with non-reactive results using commercial assays 4.
- The use of multiple assays and consideration of clinical context are important for accurate interpretation of Hepatitis B core antibody results 3, 4, 5.