From the Guidelines
When hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) are both reactive, it typically indicates a past hepatitis B virus (HBV) infection that has resolved. This pattern shows that the person was previously infected with hepatitis B but has successfully cleared the virus from their system. The presence of HBsAb means the person has developed immunity against future HBV infections, while the HBcAb indicates they were exposed to the virus at some point in their life. This combination of test results generally means the person is not currently infected and cannot transmit the virus to others. No specific treatment is needed for resolved HBV infection. However, to confirm this interpretation, it's essential to also check the hepatitis B surface antigen (HBsAg), which should be negative in resolved infections, as indicated by the guidelines from the Advisory Committee on Immunization Practices 1. If HBsAg is positive, it would suggest a chronic infection requiring medical follow-up. This antibody pattern develops because when the body fights off hepatitis B, it produces antibodies against different parts of the virus, including both the surface proteins (HBsAb) and core proteins (HBcAb), which remain detectable in the blood long after the infection has cleared. According to the most recent guidelines, individuals with this serologic pattern are considered to have recovered from past infection and are immune 1. It's also important to note that while the risk of HBV reactivation exists, especially in immunocompromised individuals, the presence of HBsAb generally indicates protective immunity, as stated in the guidelines for the management of chronic hepatitis B virus infection 1. Therefore, the combination of reactive HBsAb and HBcAb with a negative HBsAg result confirms resolved HBV infection and immunity, as supported by the evidence from the prevention of hepatitis B virus infection in the United States: recommendations of the Advisory Committee on Immunization Practices 1.
From the Research
Hepatitis B Surface Antibody and Hepatitis B Core Antibody Reactivity
- The presence of hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) can indicate a resolved hepatitis B infection or immunity due to vaccination 2, 3.
- HBsAb is considered a protective immune marker, indicating clearance of the hepatitis B virus (HBV) or immunity after vaccination 4.
- HBcAb is a sensitive serological marker for a history of HBV infection, and its presence can indicate a past or current infection 3.
- The combination of HBsAb and HBcAb reactivity may suggest that an individual has been infected with HBV in the past and has developed immunity, or has been vaccinated and has developed immunity 2, 5.
Clinical Implications
- The presence of HBsAb has been shown to protect against clinical HBV reactivation related to direct-acting antiviral therapy for hepatitis C 2.
- HBcAb-positive individuals with HBsAb positivity may have a lower risk of de novo hepatitis B virus infection (DNH) after liver transplantation 5.
- The detection of HBsAg, IgM and IgG antibodies to hepatitis B virus core antigen is important for the clinical classification and epidemiological surveillance of HBV infection 6.
Serological Interpretation
- The expression of HBsAg, anti-HBcIgM, and anti-HBcIgG serological markers in the bloodstream occurs dynamically, and changes in the patient's serological profile can occur as they progress towards recovery or chronicity 6.
- The detection of these markers is crucial for the correct clinical classification of HBV infection and epidemiological surveillance 6.
- The significance of anti-HBs in both the infection and clearance of HBV, and the potential of neutralizing antibodies and therapeutic vaccines as promising future strategies, are areas of ongoing research 4.