What are the implications of being hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) positive?

From the Guidelines

Being positive for both hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) typically indicates a past hepatitis B virus (HBV) infection that has resolved, and no specific treatment is needed for this serological pattern as the infection is no longer active. This pattern means your immune system has successfully cleared the virus, and you now have natural immunity against future HBV infections 1. However, it's essential to understand that despite clearing the virus, HBV DNA can remain in your liver cells indefinitely as covalently closed circular DNA (cccDNA) 1. In rare cases, this can reactivate if you become severely immunocompromised, such as during chemotherapy, organ transplantation, or treatment with certain immunosuppressive medications like rituximab 1.

Some key points to consider:

• If you're planning to undergo immunosuppressive therapy, your doctor should monitor your liver function and possibly consider antiviral prophylaxis with medications like entecavir or tenofovir 1.
• This antibody pattern should be documented in your medical records, and you should inform healthcare providers about your past HBV infection, especially before starting any immunosuppressive treatments 1.
• The risk of HBV reactivation can be significant, especially in patients with certain malignancies or those receiving specific immunosuppressive therapies, and prophylactic antiviral therapy may be recommended in these cases 1.
• It's crucial to follow the guidelines for prevention and treatment of cancer-related infections, including those related to HBV reactivation, as outlined in the latest clinical practice guidelines 1.

Overall, while being HBsAb and HBcAb positive generally indicates a resolved HBV infection, it's crucial to be aware of the potential risks of reactivation and take necessary precautions, especially when undergoing immunosuppressive therapy.

From the Research

Implications of Being Hepatitis B Surface Antibody and Hepatitis B Core Antibody Positive

• The presence of hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) indicates a past infection or vaccination against hepatitis B virus (HBV) 2, 3, 4.
• Being HBsAb and HBcAb positive may confer protection against HBV infection, especially in patients undergoing immunosuppressive therapy such as kidney transplantation 2 or direct-acting antiviral therapy for hepatitis C 3.
• A study found that the presence of HBsAb in addition to HBcAb reduced the risk of HBV infection in HBsAg-negative patients undergoing kidney transplantation 2.
• Another study suggested that HBsAb presence may protect against clinical HBV reactivation related to direct-acting antiviral therapy, especially if the HBsAb titre is greater than 30 iU/L 3.
• In liver transplantation, the presence of HBsAb in patients with core antibody-positive liver grafts may reduce the risk of de novo hepatitis B virus infection (DNH) 4.

Clinical Significance

• The quantitative markers of hepatitis B core-related antigen (HBcrAg) and anti-hepatitis B core antigen antibodies (HBcAb) may be useful in predicting liver fibrosis levels in chronic hepatitis B patients, especially in HBeAg-negative patients 5.
• HBsAb and HBcAb positivity may not necessarily indicate complete protection against HBV infection, and regular monitoring and prophylactic treatment may still be necessary in certain cases 2, 4.

Key Findings

• The presence of HBsAb and HBcAb is associated with a reduced risk of HBV infection and reactivation 2, 3, 4.
• HBsAb titre may play a role in determining the level of protection against HBV infection 3.
• Quantitative markers such as HBcrAg and HBcAb may be useful in predicting liver fibrosis levels in chronic hepatitis B patients 5.