From the Guidelines
High anti-HBc antibody (anti-HBc Ab) indicates previous exposure to hepatitis B virus (HBV) and requires further testing to determine the current hepatitis B status, including a complete hepatitis B panel with HBsAg, anti-HBs, and HBV DNA, as recommended by the most recent guidelines 1. This finding alone does not provide enough information to determine the current infection status, and additional testing is necessary to distinguish between resolved infection, chronic infection, or an "isolated anti-HBc" pattern. If you have isolated anti-HBc (positive anti-HBc with negative HBsAg and anti-HBs), this could represent a resolved infection with waning antibody levels, a false positive result, or occult hepatitis B infection. No specific treatment is needed for a positive anti-HBc alone, but understanding your complete hepatitis status is important for proper management, especially if you are about to undergo immunosuppressive therapy, as the risk of HBV reactivation is a concern 1. The anti-HBc antibody develops during acute infection and typically persists for life, serving as a marker of previous HBV exposure. Regular monitoring may be recommended depending on your complete test results, especially if you have risk factors for liver disease or are immunocompromised, and prophylactic antiviral therapy may be considered in certain cases, such as before starting anti-CD20 monoclonal antibody therapy 1. Key points to consider include:
- Getting a complete hepatitis B panel to determine the current infection status
- Understanding the risk of HBV reactivation, especially with immunosuppressive therapy
- Considering prophylactic antiviral therapy in high-risk cases
- Regular monitoring of liver function and HBV DNA levels as needed.
From the Research
High Anti-HBc Ab
- High anti-HBc levels have been associated with liver inflammation in chronic hepatitis B patients 2
- In HBeAg-negative chronic hepatitis B virus-infected patients with normal ALT and detectable HBV DNA, high serum anti-HBc was found to be an independent risk factor of significant liver inflammation 2
- The optimal cut-off value of serum anti-HBc for predicting significant liver inflammation was 10.87 S/CO, with a sensitivity of 59.2% and a specificity of 87.9% 2
- Isolated anti-HBc (IAHBc) is a particular serological pattern that is commonly found in immunocompromised patients, and the risk of HBV reactivation depends on host factors and viral factors 3
- Nucleos(t)ide analogues (NAs) are used to treat patients with chronic hepatitis B, and they have been shown to modify the natural history of the disease and reduce the risk of developing hepatocellular carcinoma (HCC) 4, 5
Treatment Options
- NAs such as entecavir (ETV) and tenofovir (TDF) are recommended as first-line therapy for patients with HBeAg-positive chronic hepatitis B 4, 6
- Tenofovir alafenamide (TAF) is a new tenofovir prodrug that has been developed to overcome the less favourable safety profile of TDF, and it has been shown to be at least as effective as TDF with fewer kidney disturbances and changes in bone mineral density 5
- The European Association for the Study of the Liver has suggested selecting TAF or ETV instead of TDF in patients >65 years old and in those with a risk of osteoporosis or renal abnormalities 5
Patient Management
- Patients with HBeAg-positive CHB should consider pegylated interferon if they are aged < 40 years, have lower HBV DNA levels, can afford this treatment, and have a lifestyle that would support adherence to injection therapy 6
- Alternatively, NAs are recommended in patients with alanine aminotransferase levels ≥ 2 × the upper limit of normal, HBV DNA levels < 9 log(10) IU/ml, and compensated CHB 6
- In patients at high risk of HBV reactivation, HBV therapy has to be considered systematically, while in patients at moderate risk, the decision is based on the level of HBV DNA (preemptive treatment or monitoring and vaccination) 3