Hepatitis B Core Antibody Total Interpretation

Introduction to Anti-HBc

A positive total hepatitis B core antibody (anti-HBc) indicates past or present hepatitis B virus infection and persists for life in the majority of persons, according to the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1

The American College of Physicians recommends that to determine whether the infection is acute, chronic, or resolved, additional serologic markers (HBsAg, anti-HBs, and IgM anti-HBc) are required, as stated in MMWR Recommendations and Reports 1
The presence of HBsAg indicates active infection, as indicated by the Centers for Disease Control and Prevention 1
The presence of anti-HBs indicates immunity, as indicated by the Centers for Disease Control and Prevention 1
The presence of IgM anti-HBc distinguishes acute from chronic infection, according to the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1

A serologic panel showing HBsAg positive + Total anti-HBc positive + IgM anti-HBc positive indicates acute hepatitis B, as stated by the American Association for the Study of Liver Diseases 1
A serologic panel showing HBsAg positive + Total anti-HBc positive + IgM anti-HBc negative indicates chronic hepatitis B, according to the American Association for the Study of Liver Diseases 1
A serologic panel showing HBsAg negative + Total anti-HBc positive + Anti-HBs positive indicates past infection with immunity, as indicated by the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1

Isolated anti-HBc positivity can represent resolved infection with waning anti-HBs, occult chronic infection, or false-positive reaction, as stated by the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1

Persons positive only for anti-HBc are unlikely to be infectious except under unusual circumstances involving direct percutaneous exposure to substantial quantities of virus, according to the Centers for Disease Control and Prevention, as reported in MMWR Recommendations and Reports 1
Patients who are HBcAb-positive face risk of HBV reactivation with profound immunosuppression, as stated by the National Comprehensive Cancer Network 5
Serum HBV DNA testing before starting immunosuppressive therapy helps define reactivation risk, according to the National Comprehensive Cancer Network 5
IgM anti-HBc testing should be limited to persons with clinical evidence of acute hepatitis or epidemiologic link to HBV infection due to low positive predictive value in asymptomatic persons, as stated by the American Association for the Study of Liver Diseases 1

An individual vaccinated for HBV typically has: HBsAg negative, anti-HBs positive, and anti-HBc negative, as indicated by the National Comprehensive Cancer Network 5