From the Guidelines
Yes, a positive hepatitis B core antibody (anti-HBc), negative hepatitis B surface antigen (HBsAg), and reactive hepatitis B surface antibody (anti-HBs) pattern is consistent with prior hepatitis B infection with subsequent recovery and immunity. This serological profile indicates that you were previously infected with the hepatitis B virus, your body successfully cleared the infection, and you have developed protective antibodies. The hepatitis B core antibody remains positive for life after infection, while the absence of surface antigen confirms the virus is no longer actively replicating in your liver. The presence of surface antibodies (anti-HBs) at levels above 10 mIU/mL indicates protective immunity against future hepatitis B infections, as noted in the study by 1. This immunity is generally considered lifelong, and no further vaccination or treatment is needed. Your liver function tests should be normal, but it's reasonable to verify this with your healthcare provider. This pattern differs from vaccination-induced immunity, which would show positive anti-HBs but negative anti-HBc, as the vaccine contains only the surface antigen and doesn't trigger core antibody production. Some key points to consider include:
- The risk of HBV reactivation is higher in patients with negative anti-HBs than in those who are anti-HBs–positive, as supported by the study 1.
- Patients with past HBV and a hematologic malignancy anticipating anti-CD20 or stem-cell transplantation have a high risk of HBV reactivation and should start antiviral prophylaxis prior to anticancer therapy, as recommended by 1.
- The presence of anti-HBs is generally indicative of immunity to HBV infection, as stated in the study 1. It is essential to note that while this serological profile indicates immunity, it is crucial to continue monitoring liver function and be aware of the potential for HBV reactivation in the context of immunosuppression, as discussed in the study 1.
From the Research
Hepatitis B Infection Status
- The presence of hepatitis B core antibody (anti-HBc) indicates a past or current infection with hepatitis B virus (HBV) 2, 3, 4.
- A negative hepatitis B surface antigen (HBsAg) result suggests that the individual is not currently infected with HBV 2, 5, 4.
- The presence of hepatitis B surface antibody (anti-HBs) in addition to anti-HBc confers protection against HBV infection in HBsAg-negative patients 4.
Interpretation of Serological Markers
- The detection of HBsAg, anti-HBc, and anti-HBs are important for the clinical classification and epidemiological surveillance of HBV infection 6, 3.
- The expression of these markers in the bloodstream occurs dynamically, and changes in the patient's serological profile can occur as they progress towards recovery or chronicity 3.
- The presence of anti-HBc and anti-HBs in an individual with a negative HBsAg result is consistent with prior infection and current immunity to HBV 4.
Clinical Implications
- Patients with a positive anti-HBc result and a negative HBsAg result, but with a reactive anti-HBs result, are considered to be at low risk of HBV reactivation 2, 4.
- Monitoring for HBV infection is recommended for HBsAg-negative, anti-HBc-positive, and anti-HBs-negative patients undergoing immunosuppressive therapy, such as kidney transplantation 4.