Interpretation of Hepatitis B Core Antibody Total and Hepatitis B Surface Antibody
A positive hepatitis B core antibody (anti-HBc) total indicates past or present HBV infection at some point in your life, while a positive hepatitis B surface antibody (anti-HBs) indicates immunity to HBV—either from recovery after natural infection or from vaccination. 1
Understanding Hepatitis B Core Antibody Total (Anti-HBc Total)
Anti-HBc total appears during acute HBV infection and persists for life, regardless of whether the infection resolves or becomes chronic. 1 This antibody includes both IgM and IgG components, though only the total (combined) measurement is typically performed in standard testing. 1
The key limitation is that anti-HBc total alone cannot distinguish between acute infection, chronic infection, or resolved past infection—you need additional markers to determine your current HBV status. 1, 2
Understanding Hepatitis B Surface Antibody (Anti-HBs)
Anti-HBs indicates recovery from and immunity to HBV infection, resulting from either natural infection or vaccination. 1 When anti-HBs is present at levels ≥10 mIU/mL, you are considered immune and protected against future HBV infection. 1
In most patients who clear acute HBV infection naturally, HBsAg (the surface antigen indicating active infection) and anti-HBs are not detectable simultaneously in blood. 1
Interpreting the Combination of Both Positive Results
When both anti-HBc total and anti-HBs are positive together (with negative HBsAg), this indicates resolved past HBV infection with immunity. 1, 2 This is the most common interpretation of this serologic pattern and means:
- You were infected with HBV at some point in the past 1
- Your immune system successfully cleared the infection 1
- You now have natural immunity and are protected against future HBV infection 1
- You are not currently infectious and do not have active HBV 1
Complete Serologic Interpretation Algorithm
To fully understand your HBV status, the complete panel interpretation follows this pattern: 1, 2
If HBsAg is negative + anti-HBc total is positive + anti-HBs is positive:
- Interpretation: Resolved past infection with immunity 1, 2
- No further HBV vaccination needed 1
- No risk of transmitting HBV to others 1
If HBsAg is positive + anti-HBc total is positive + IgM anti-HBc is positive:
If HBsAg is positive + anti-HBc total is positive + IgM anti-HBc is negative:
If HBsAg is negative + anti-HBc total is positive + anti-HBs is negative:
- Interpretation: Uncertain—could represent false-positive anti-HBc, low-level chronic infection, or the "window period" during acute infection 1
- Requires HBV DNA testing to clarify 1
Clinical Significance of Your Results
With both anti-HBc total and anti-HBs positive (assuming HBsAg is negative), you have protective immunity and require no further HBV vaccination or treatment. 1, 2 This serologic pattern indicates your immune system has successfully dealt with a past HBV exposure and you are now protected. 1
Important Caveats
The "window period" is a rare exception where HBsAg has disappeared but anti-HBs has not yet appeared—during this brief time, only anti-HBc may be detectable. 1 However, if anti-HBs is also positive in your case, this window period scenario does not apply. 1
In dialysis patients specifically, anti-HBc positive with anti-HBs >10 IU/mL indicates immunity from prior infection and no further testing is required. 2
False-positive anti-HBc results can occur, particularly isolated anti-HBc positivity without other markers, which may represent past infection, false-positive results, or low-level chronic infection. 1, 3 However, when accompanied by positive anti-HBs, this is much less likely to be a false-positive pattern. 1