From the Guidelines
When both Hepatitis B core antibody (anti-HBc) and Hepatitis B surface antibody (anti-HBs) are reactive, this typically indicates a past Hepatitis B virus (HBV) infection that has resolved, as indicated by the most recent guidelines from the American Association for the Study of Liver Diseases 1. This pattern shows that your body was previously infected with HBV but has successfully cleared the virus and developed immunity. The core antibody develops during infection and remains detectable for life, while the surface antibody indicates protective immunity that developed after the infection cleared. This is generally a favorable result as it means you are now immune to HBV and cannot be reinfected. No specific treatment is needed for resolved HBV infection. However, it's essential to confirm this interpretation with a negative Hepatitis B surface antigen (HBsAg) test, which would verify the absence of active infection, as recommended by the National Comprehensive Cancer Network 1. In rare cases, this antibody pattern could represent a chronic infection with low viral levels, so your healthcare provider might recommend additional testing such as HBV DNA to completely rule out active infection, as suggested by the American College of Rheumatology 1. Some key points to consider include:
- The risk of HBV reactivation in patients with resolved HBV infection (HBsAg-negative, anti-HBc-positive, and anti-HBs-positive) is generally low, but it can occur, especially in the setting of significant immunosuppression, as noted in the guidelines for the treatment of rheumatoid arthritis 1.
- Prophylactic antiviral therapy may be recommended for patients at high risk of HBV reactivation, such as those receiving anti-CD20 therapy or stem cell transplantation, as recommended by the American Association for the Study of Liver Diseases 1.
- Patients with past HBV infection should be monitored closely for signs of HBV reactivation, including elevated liver enzymes and HBV DNA levels, as suggested by the guidelines for the diagnosis and management of autoimmune hepatitis in adults and children 1. It is crucial to consult with a healthcare provider to determine the best course of action based on individual circumstances and to ensure that any necessary precautions are taken to prevent HBV reactivation, especially in patients requiring immunosuppressive therapy, as emphasized by the American College of Rheumatology 1 and the National Comprehensive Cancer Network 1.
From the Research
Hepatitis B Core Antibody and Hepatitis B Surface Antibody Reactivity
- The presence of both hepatitis B core antibody (anti-HBc) and hepatitis B surface antibody (anti-HBs) indicates that an individual has been exposed to the hepatitis B virus (HBV) and has developed immunity to it 2, 3.
- The reactivity of both anti-HBc and anti-HBs suggests that the individual has either recovered from an HBV infection or has been vaccinated against HBV 4.
- Studies have shown that the presence of anti-HBs in addition to anti-HBc confers protection against HBV infection in individuals undergoing kidney transplantation 3 and may also protect against HBV reactivation during direct-acting antiviral therapy for hepatitis C 2.
- The levels of anti-HBs and anti-HBc can impact the risk of HBV reactivation, with lower levels of anti-HBs (<100 mIU/mL) and higher levels of anti-HBc (≥100 cut off index) increasing the risk of reactivation 5.
Clinical Implications
- Individuals with reactive anti-HBc and anti-HBs may still be at risk of HBV reactivation, particularly if they have low levels of anti-HBs or are undergoing immunosuppressive therapy 2, 5.
- Monitoring for HBV infection is recommended for individuals with reactive anti-HBc and anti-HBs who are undergoing immunosuppressive therapy or have other risk factors for HBV reactivation 3, 5.
- The presence of anti-HBs and anti-HBc can provide protection against HBV infection, but it is essential to consider the levels of these antibodies and other risk factors when assessing the risk of HBV reactivation 2, 3, 5.