Serologic Interpretation
This patient has immunity to hepatitis A from either past infection or vaccination, immunity to hepatitis B from vaccination (not natural infection), and no evidence of hepatitis C infection—no further management or treatment is required. 1
Hepatitis A Status
- Positive HAV total antibody with negative IgM indicates past resolved infection or successful vaccination, not active disease. 2
- The HAV total antibody assay detects both IgG and IgM but does not differentiate between them; a positive result with negative IgM confirms immunity rather than acute infection. 2
- IgM anti-HAV is the definitive marker for acute hepatitis A infection and becomes positive 5-10 days before symptom onset, remaining positive for 6-12 months. 2, 3
- Since IgM is negative, this patient either received hepatitis A vaccination or had a prior asymptomatic or resolved infection—both scenarios confer lifelong immunity. 2
Hepatitis B Status
- The serologic pattern of HBsAg negative, anti-HBs reactive (>10 mIU/mL), and anti-HBc negative definitively indicates immunity from hepatitis B vaccination, not natural infection. 2, 1
- This is the classic post-vaccination profile: patients who respond adequately to hepatitis B vaccines test negative for anti-HBc and positive for anti-HBs, since anti-HBc emerges only after actual HBV infection and persists for life. 2, 1
- The absence of anti-HBc excludes all forms of natural HBV exposure, including acute infection, chronic infection, resolved infection, and occult hepatitis B. 2, 1
- Anti-HBs levels greater than 10 mIU/mL provide evidence of protective immunity against future HBV infection. 2
Hepatitis C Status
- Non-reactive HCV antibody indicates no current or past hepatitis C infection. 2
- Available serologic tests for anti-HCV do not distinguish between acute and chronic or past infection, so a negative result effectively rules out HCV exposure. 2
- No further HCV testing (such as HCV RNA) is indicated in an asymptomatic patient with negative antibody. 2
Management Recommendations
No Active Disease Management Required
- No antiviral therapy, monitoring, or specialist referral is indicated for this patient. 1
- This serologic profile represents complete immunity to hepatitis A and B with no evidence of hepatitis C—this is the ideal outcome for viral hepatitis screening. 2, 1
Future Considerations
- Anti-HBs titers may decline over time (typically after 10-15 years), but immunologic memory persists and booster vaccination is not routinely recommended for immunocompetent individuals. 2
- If this patient ever requires immunosuppressive therapy, chemotherapy, or biologic agents in the future, anti-HBs levels should be rechecked and prophylactic antiviral therapy considered if levels fall below 10 mIU/mL, though reactivation risk is minimal with vaccination-induced immunity alone. 3, 4
- Hepatitis C screening should be repeated only if future risk factors develop (such as injection drug use, blood transfusion before 1992, or high-risk sexual exposure). 2
Critical Pitfalls to Avoid
- Do not misinterpret positive HAV total antibody as active infection—always check IgM to differentiate immunity from acute disease. 2, 5
- In rare cases (5-10%), early acute hepatitis A can show anti-HAV total reactive but IgM non-reactive due to assay sensitivity differences; however, this patient's negative IgM makes acute infection extremely unlikely in the absence of clinical hepatitis symptoms. 5
- Do not confuse vaccination-induced immunity (anti-HBs positive, anti-HBc negative) with natural infection immunity (anti-HBs positive, anti-HBc positive)—the presence or absence of anti-HBc is the key distinguishing feature. 2, 1
- False-positive isolated HBsAg can occur due to heterophilic antibody interference, but this patient's negative HBsAg eliminates this concern. 6