Interpretation of Hepatitis B Core Antibody Test Results

Introduction to Hepatitis B Core Antibody

A positive Hepatitis B core antibody (total) test result indicates past or present infection with the hepatitis B virus (HBV), but does not by itself determine whether the infection is acute, chronic, or resolved, as stated by the Centers for Disease Control and Prevention (CDC) 1, 2
The American Association for the Study of Liver Diseases recommends that a positive total anti-HBc test indicates that the person has been infected with HBV at some point in their life 2, 3
The Infectious Diseases Society of America notes that this antibody appears during acute infection and typically persists for life, regardless of whether the infection resolves or becomes chronic 1
Total anti-HBc includes both IgM and IgG antibodies to the hepatitis B core antigen, according to the Clinical Infectious Diseases journal 1

Additional serologic markers are required to determine the complete HBV status, including HBsAg, anti-HBs, and IgM anti-HBc, as recommended by the CDC 1, 2
The presence of anti-HBs indicates immunity, as stated by the American Journal of Kidney Diseases 4
The complete interpretation depends on the pattern of all these markers together, according to the MMWR Recommendations and Reports 2, 3

HBsAg positive + Total anti-HBc positive + IgM anti-HBc positive = Acute HBV infection, as defined by the CDC 2, 3
HBsAg positive + Total anti-HBc positive + IgM anti-HBc negative = Chronic HBV infection, according to the MMWR Recommendations and Reports 2, 3
HBsAg negative + Total anti-HBc positive + Anti-HBs positive = Resolved HBV infection with immunity, as stated by the CDC 2, 3

In dialysis patients, a positive total anti-HBc with positive anti-HBs (>10 IU/mL) indicates immunity from prior infection and no further testing is required, according to the American Journal of Kidney Diseases 4, 5
In HIV-infected patients, HBV vaccination should be administered to those with positive total anti-HBc but negative HBsAg and anti-HBs results (and no detectable HBV DNA), as recommended by the Clinical Infectious Diseases journal 6
Patients with chronic HBV infection require referral to a provider experienced in managing such infections, as stated by the MMWR Recommendations and Reports 2