From the Guidelines
Hepatitis B core reactive or positive indicates that you have been infected with the hepatitis B virus at some point in your life, and additional tests such as hepatitis B surface antigen (HBsAg) and hepatitis B surface antibody (anti-HBs) are needed to determine your current infection status. This test detects antibodies to the core protein of the hepatitis B virus, and a positive result can signify either a current active infection or a past infection that your body has resolved 1.
Interpretation of Test Results
To understand the implications of a hepatitis B core reactive or positive result, it's essential to consider the following:
- A positive hepatitis B core antibody result appears early in infection and typically remains detectable for life, making it useful for identifying anyone who has ever been infected with the virus.
- If HBsAg is positive, it indicates an active infection that requires medical attention.
- If anti-HBs is positive, it signifies immunity from a past infection or vaccination.
Clinical Implications
Patients with a history of hepatitis B infection, as indicated by a positive hepatitis B core antibody test, are at risk for reactivation of HBV infection when undergoing immunosuppressive therapy 1. The risk of reactivation can be estimated based on the serological profile and the type, dose, and duration of immunosuppressive therapy.
Management and Prevention
Depending on the risk category, a preemptive treatment or monitoring strategy with the intent of on-demand therapy can be developed 1. Prophylactic antiviral therapy, preferably with entecavir or tenofovir, during immunosuppressive treatment and for at least 6 months after treatment (or at least 12 months after treatment with anti-CD20 agents), has been recommended for individuals at high to moderate risk of HBV reactivation.
Recommendations
You should consult with a healthcare provider for proper interpretation of your complete hepatitis panel and appropriate follow-up. No specific medication is needed if you only have core antibodies without active infection, but your doctor may recommend monitoring liver function tests periodically.
From the Research
Hepatitis B Core Reactive and Hepatitis Core Positive
- Hepatitis B core reactive and hepatitis core positive refer to the presence of hepatitis B core antibody and hepatitis B core antigen in the blood, indicating a current or past infection with hepatitis B virus (HBV) 2.
- The hepatitis B core antibody is a marker of prior HBV exposure, while the hepatitis B core antigen is a component of the HBV virus itself 3.
- A positive hepatitis B core antibody test result indicates that the individual has been infected with HBV at some point in their lives, while a positive hepatitis B core antigen test result indicates active viral replication 4.
Implications of Hepatitis B Core Reactive and Hepatitis Core Positive
- Individuals with chronic HBV infection, defined as having a positive hepatitis B surface antigen, are at risk of reactivation, which can occur spontaneously or be triggered by immunosuppressive therapies 2.
- The presence of hepatitis B core-related antigen has been shown to be a promising serological marker for monitoring HBV cure, with decreasing levels corresponding to sustained viral suppression 3.
- Hepatitis B core protein has been identified as a therapeutic target, with novel agents being developed to target alternative viral replication steps 5.
Predicting Clinical Relapse
- The combination of end-of-treatment hepatitis B core-related antigen and hepatitis B virus RNA levels has been shown to be predictive of clinical relapse after nucleos(t)ide analogue therapy discontinuation 6.
- Patients with undetectable hepatitis B core-related antigen and hepatitis B virus RNA at the end of treatment were found to have a lower risk of clinical relapse compared to those with detectable levels of one or both biomarkers 6.