Interpretation of Positive Hepatitis B Core Antibody and Surface Antibody with Negative Surface Antigen
This serologic pattern (HBsAg negative, anti-HBc positive, anti-HBs positive) indicates you have recovered from a past hepatitis B infection and now have natural immunity. 1, 2
What This Means Clinically
You are not currently infectious and cannot transmit hepatitis B to others. 3 This pattern demonstrates:
- Clearance of active virus from your bloodstream after a previous HBV exposure 2
- Development of protective immunity through natural infection rather than vaccination 1, 3
- Lifelong presence of core antibody (anti-HBc), which appears during acute infection and persists indefinitely as a marker of past exposure 2
The presence of surface antibody (anti-HBs) alongside core antibody confirms resolved infection with immunity, distinguishing this from isolated core antibody positivity alone. 1, 2
For Immunocompetent Individuals
No further routine testing or treatment is typically required if you are healthy and not planning immunosuppressive therapy. 2 You are:
- Generally not at risk for developing chronic HBV infection 2
- Protected against future HBV reinfection by your anti-HBs antibodies 3
Critical Caveat: Risk with Immunosuppression
If you require immunosuppressive therapy in the future, you face a 3-45% risk of HBV reactivation despite having cleared the infection. 2 This risk varies based on:
- Type of immunosuppressive regimen (highest with anti-CD20/CD52 monoclonal antibodies or high-dose corticosteroids) 2
- Your underlying disease 2
- Presence of detectable HBV DNA in your bloodstream 2
Management Before Immunosuppression
HBV DNA testing must be performed before starting any immunosuppressive therapy to define your reactivation risk. 2 If you are viremic (detectable HBV DNA), antiviral prophylaxis should be initiated. 2 Monitoring of liver function tests is recommended throughout immunosuppressive treatment. 2
Research data shows that patients with this serologic pattern on anti-TNF therapy have relatively low reactivation rates (0.8-2.5%), but the risk is not zero. 4
Common Pitfall to Avoid
Do not confuse this pattern with vaccine-derived immunity, which shows anti-HBs positive but anti-HBc negative. 3 The presence of anti-HBc in your case confirms natural infection history, meaning dormant viral DNA may persist in liver tissue even when undetectable in serum. 2, 5 This is why reactivation risk exists with immunosuppression, whereas vaccine-derived immunity carries minimal reactivation risk. 3