Interpretation of Isolated Hepatitis B Core Antibody

Authors: Jeanne Marrazzo, MD, MPH Chia C. Wang, MD, MS

Last updated: February 17, 2006

Learning Objectives

A 36-year-old injection-drug user presents for follow-up management of cellulitis. As part of his general medical evaluation he undergoes serologic testing for hepatitis. His results show a positive antibody for hepatitis C (HCV) and negative hepatitis A (HAV) antibody. Results from his hepatitis B virus (HBV) serology panel show the following:

  • Hepatitis B surface antigen (HBsAg): negative
  • Hepatitis B surface antibody (anti-HBs): negative
  • Hepatitis B core antibody (anti-HBc), total IgM and IgG: positive
  • Hepatitis B core antibody, IgM (IgM anti-HBc): not performed

The patient began injecting drugs at age 23 and he continues to regularly inject drugs. He does not recall ever having had acute HBV infection and he does not ever remember receiving HBV vaccine.

Which of the following serologic profiles would be most consistent with acute HBV infection?

A A finding of isolated anti-HBc may represent either acute or past infection with hepatitis B.
B The isolated anti-HBc test has a greater than 95% likelihood of representing a false positive result, and thus the patient should be considered negative for acute or prior HBV infection.
C A finding of isolated anti-HBc most likely represents a weak response to hepatitis B vaccine, and the patient probably just doesn't remember that he's been vaccinated.
D Persons with HIV and chronic HCV infection have the lowest prevalence of isolated anti-HBc because they generate enhanced levels of anti-HBs that remain elevated on a long-term basis.