HBV DNA Testing for Positive Hepatitis B Core Antibody with Negative Surface Antibody

Interpretation of Serologic Pattern

The pattern of positive anti-HBc with negative anti-HBs can indicate several clinical scenarios, including resolved past HBV infection with waning anti-HBs levels, occult hepatitis B infection with low-level HBV replication, false-positive anti-HBc test result, or window period during acute HBV infection, as noted by the Clinical and Molecular Hepatology journal 1
This serologic pattern requires further investigation as it may represent chronic infection that could lead to liver disease progression, according to the Clinical and Molecular Hepatology journal 1

HBV DNA testing should be performed to determine if there is active viral replication, as recommended by the Clinical and Molecular Hepatology journal 1
If HBV DNA is positive, this confirms chronic HBV infection, as stated by the Clinical and Molecular Hepatology journal 1
Liver function tests should be performed to assess for liver inflammation, with elevated ALT/AST indicating active hepatitis, as noted by the Hepatology journal 4

If HBV DNA is positive, the patient should be evaluated for chronic hepatitis B with liver biopsy if there is persistent or intermittent elevation in aminotransferase levels, as recommended by the Hepatology journal 4
Treatment may be indicated depending on viral load, ALT levels, and evidence of liver damage, according to the Clinical and Molecular Hepatology journal 1
If HBV DNA is negative, consider hepatitis B vaccination, as recommended by KASL guidelines, and monitor liver function tests periodically, as noted by the Clinical and Molecular Hepatology journal 1

Patients with this serologic profile are at risk for HBV reactivation if they undergo immunosuppressive therapy, and pre-emptive antiviral therapy may be needed, as recommended by the Clinical and Molecular Hepatology journal and other guidelines 1, 2
Some patients may have HBV DNA in the liver despite negative serum HBV DNA, which is more common in patients with chronic liver disease from other causes, as noted by the Clinical and Molecular Hepatology journal 1

Hepatitis A vaccination is recommended for patients with evidence of HBV infection to prevent additional liver injury, as recommended by the Clinical and Molecular Hepatology journal 1
Sexual and household contacts of HBV carriers should be tested and vaccinated if negative for HBV markers, as recommended by the Hepatology journal 4