From the Guidelines
A positive Hepatitis B core antibody (anti-HBc) total test indicates that you have been infected with the Hepatitis B virus at some point in your life, and to fully understand your situation, additional tests such as Hepatitis B surface antigen (HBsAg) and Hepatitis B surface antibody (anti-HBs) are needed. This antibody appears during acute infection and typically remains detectable for life 1. However, a positive anti-HBc total alone doesn't tell the complete story of your Hepatitis B status. If HBsAg is positive, you have an active infection. If anti-HBs is positive and HBsAg is negative, you've recovered from a past infection and have immunity. Sometimes, anti-HBc may be the only positive marker (isolated anti-HBc), which could indicate a false positive result, a resolving acute infection, or a chronic infection with low viral levels.
According to the most recent guidelines, all patients with cancer anticipating systemic anticancer therapy should be tested for hepatitis B virus (HBV) by 3 tests—hepatitis B surface antigen (HBsAg), hepatitis B core antibody (anti-HBc) total immunoglobulin (Ig) or IgG, and antibody to hepatitis B surface antigen (anti-HBs)—prior to, or at the beginning of, systemic anticancer therapy 1. No specific treatment is needed for a positive anti-HBc alone, but follow-up testing is important to determine your complete Hepatitis B status and whether any treatment or monitoring is necessary. Patients with past HBV receiving anticancer therapies associated with an established high risk of HBV reactivation should be started on antiviral prophylaxis at the beginning of anticancer therapy and continued on antiviral therapy for at least 12 months after the cessation of anticancer therapy 1.
Key points to consider:
- A positive anti-HBc total test indicates past or present infection with Hepatitis B virus
- Additional tests such as HBsAg and anti-HBs are needed to determine the complete Hepatitis B status
- Patients with cancer anticipating systemic anticancer therapy should be tested for HBV prior to therapy
- Antiviral prophylaxis is recommended for patients with past HBV receiving high-risk anticancer therapies
- Follow-up testing is important to determine the need for treatment or monitoring.
From the Research
Hepatitis B Core Antibody (HBcAb) Total Positive Meaning
- A positive HBcAb total test result indicates that the individual has been exposed to the hepatitis B virus (HBV) at some point in their life 2.
- The presence of HBcAb total can be used to differentiate between acute and chronic HBV infection, as well as to monitor the progression of the disease 2.
- The level of HBcAb has been shown to be associated with the seroclearance of HBV DNA and HB surface antigen in HBeAg-seronegative patients, with higher levels of anti-HBc (<3 log IU/mL) corresponding to a higher likelihood of seroclearance 3.
- Quantification of HBcAb can be used as a new index to reflect the immune activation state of HBV infection and is related to the inflammatory state of the host liver 4.
- The combined detection of HBcAb quantification and other indicators, such as HBsAg and HBV DNA, has shown promising efficiency for staging chronic hepatitis B (CHB) and can assist in the diagnosis and treatment of the disease 4.
Clinical Implications
- A positive HBcAb total test result can be used to identify individuals who are at risk of developing chronic HBV infection and to monitor their response to treatment 5.
- The level of HBcAb can be used to predict the likelihood of HBsAg seroconversion, which is an important treatment endpoint for CHB patients 3.
- The detection of HBcAb total, along with other serological markers, can be used to classify the clinical form of HBV infection and to conduct epidemiological surveillance of hepatitis B 2.