Non-Reactive Hepatitis B Core Antibody (Anti-HBc)
A non-reactive (negative) hepatitis B core antibody test indicates you have never been infected with hepatitis B virus. 1, 2, 3
What This Result Means
No Prior HBV Infection
- A negative anti-HBc result means no past or current hepatitis B infection has occurred. 1, 3
- Anti-HBc appears during acute HBV infection and typically persists for life in anyone who has been infected, regardless of whether the infection resolved or became chronic. 3
- The absence of this antibody definitively rules out prior natural HBV exposure. 3
Complete Interpretation Requires Additional Tests
Your complete hepatitis B status depends on the pattern of all serologic markers together:
- HBsAg negative + Anti-HBc negative + Anti-HBs negative = Never infected, susceptible to HBV 1, 2, 3
- HBsAg negative + Anti-HBc negative + Anti-HBs positive = Immunity from hepatitis B vaccination 2, 3
Clinical Implications
If You Have No Anti-HBs (Surface Antibody)
- You are susceptible to hepatitis B infection and should receive hepatitis B vaccination. 1
- The standard vaccination schedule is 0,1, and 6 months, though alternative schedules (0,1,4 months or 0,2,4 months) are also approved. 1
- Vaccination should be administered intramuscularly in the deltoid muscle. 1
If You Have Positive Anti-HBs
- The pattern of negative HBsAg, negative anti-HBc, and positive anti-HBs indicates vaccine-derived immunity. 2, 3
- You are protected against hepatitis B infection and cannot transmit the virus to others. 2
- No further routine testing is typically required in immunocompetent individuals. 2
Special Populations Requiring Vaccination
If you fall into any of these high-risk categories and lack immunity, hepatitis B vaccination is strongly recommended: 1
- Sexually active individuals with multiple partners or recent STD diagnosis 1
- Healthcare workers with potential blood exposure 1
- Injection drug users 1
- Household or sexual contacts of persons with chronic HBV infection 1
- Persons receiving hemodialysis 1
Important Caveats
Rare Exception: Occult Infection
- In extremely rare cases (primarily in severely immunosuppressed patients), chronic HBV infection can exist without detectable anti-HBc, though this represents less than 1% of chronic infections. 4
- This is clinically irrelevant for immunocompetent individuals with negative anti-HBc. 4
Immunosuppression Considerations
- If you require immunosuppressive therapy and have vaccine-derived immunity (anti-HBs positive, anti-HBc negative), the risk of HBV reactivation is minimal because you have no prior natural infection that could reactivate. 2
- Annual anti-HBs monitoring may be recommended in certain high-risk settings like dialysis units. 2