From the Guidelines
Being hepatitis B core antibody (HBcAb) positive and surface antibody (HBsAb) positive typically indicates a past hepatitis B infection that has resolved, and this pattern suggests that the individual has developed immunity against future infections. This serological pattern is characterized by the presence of both HBcAb and HBsAb, indicating that the individual's immune system has encountered the hepatitis B virus and successfully fought it off. The core antibody (HBcAb) appears when an individual has been infected with the virus, while the surface antibody (HBsAb) develops either after recovery from natural infection or after vaccination 1.
When both HBcAb and HBsAb are present together without the hepatitis B surface antigen (HBsAg), it suggests that the body has cleared the virus and the individual is not currently infected. This immunity is generally considered lifelong, so vaccination against hepatitis B is not necessary 1. However, it is essential to inform healthcare providers about this status, as some immunosuppressive treatments might potentially reactivate dormant virus in rare cases.
Some key points to consider include:
- The presence of HBcAb and HBsAb without HBsAg indicates a resolved infection and immunity to hepatitis B 1.
- Individuals with this serological pattern do not require vaccination against hepatitis B but should be monitored for potential reactivation during immunosuppressive therapy 1.
- The risk of reactivation is higher in individuals with HBcAb positivity, even if HBsAb is also present, especially during treatment with anti-CD20 monoclonal antibodies or stem cell transplantation 1.
- Antiviral prophylaxis may be considered for individuals with HBcAb positivity who are undergoing immunosuppressive therapy to prevent reactivation 1.
Overall, being HBcAb positive and HBsAb positive is a common serological pattern worldwide, especially in regions where hepatitis B is endemic, and does not typically require specific treatment or monitoring if liver function tests are normal 1.
From the Research
Hepatitis B Core Antibody and Surface Antibody Positivity
- Being hepatitis B core antibody (HBcAb) positive and surface antibody (HBsAb) positive indicates that an individual has been infected with hepatitis B virus (HBV) in the past and has developed immunity to the virus 2, 3.
- The presence of HBcAb suggests that the individual has been exposed to HBV and has mounted an immune response, while the presence of HBsAb indicates that the individual has developed immunity to the virus and is no longer infectious 4.
- This combination of antibodies is often seen in individuals who have recovered from acute HBV infection and have developed a strong immune response to the virus 2, 3.
Interpretation of Test Results
- The results of HBcAb and HBsAb tests should be interpreted in conjunction with other laboratory tests, such as liver function tests and HBV DNA testing, to determine the individual's current infection status and liver disease activity 5, 4.
- A positive HBcAb result in the absence of HBsAb may indicate a current or past HBV infection, while a positive HBsAb result in the absence of HBcAb may indicate vaccination against HBV 2, 3.
Clinical Implications
- Individuals who are HBcAb positive and HBsAb positive are generally considered to be immune to HBV and are not at risk of transmitting the virus to others 4.
- However, these individuals may still be at risk of developing liver disease, such as cirrhosis or hepatocellular carcinoma, if they have underlying liver damage or other risk factors 5, 4.
- Regular monitoring of liver function and disease activity is recommended for individuals with a history of HBV infection, regardless of their current infection status 5, 4.