Hi there, newbie here. I am an immigrant here in Europe, I am from Southeast Asia. I would like to ask, is there anybody here who has the same case as me? I am anti-hbc positive. I never had symptoms of hepatitis b in the past and never been diagnosed with having the virus. I first learned that I am anti-hbc positive when the blood bank notified me about the positive result (March 2025). After that, they extracted me again for a repeat test, and I am still waiting for the result. But since the release of the results is taking longer, I had to confirm it from the other laboratory, the result was both positive for anti hbs and anti hbc. At first, I was thinking that it might be a false positive result since I have a vaccine for hepatitis b in 2010 (3 doses). I also had checked my anti-hbs back in 2017, and it was 1010 mUI/mL. I am a bit confused with my situation. Is it a case of vaccine failure? Am I infected before with other strain of HBV? I am HBsAg negative.
Thank you in advance!
Hi @Tom,
Welcome to the community. Thanks for sharing these results and your question. There are a few things here: First, you are still protected with immunity against HBV, as noted by positive anti-HBs.
Second, with anti-HBc being positive, indicating an exposure from the past. Is it possible your immunity may have come from your body clearing the virus and developing these antibodies rather than from a vaccine? That is a possibility. But it is hard to tell since I don’t know if your anti-HBs was tested and measured before getting the vaccine.
With that said, you do not have to worry since you have protection against HBV (712 mIU/mL), even though it dropped from where it was back in 2017 (1010). Anti-HBs positive means you have immunity against HBV, and anti-HBc positive means you were exposed in the past to HBV, and surface antigen negative means you do not have HBV. I hope this helps clear up any confusion. Bansah1
@Bansah1
Thank you for your clear advice and reassurance, really appreciate it. Regarding anti-HBs, I never tested for it before my vaccination in 2010. I just tested HBsAg which was negative, and then proceeded to hepatitis B vaccination since it was a requirement back then before I was admitted to the university for my tertiary education. My first anti-HBs titer was in 2017 and the result was 1010 mUI/mL, which I don’t have any idea if the immunity is coming from my own body or from the vaccine itself.
I still have another concern. I had several blood donations back in my home country and never received any notifications regarding my anti-HBc status. I had donated twice as well here in Europe in August 2021 and still no notification about anti-HBc positivity, only this year in March I got notified about this positive test result which really made me feel shocked and confused. Is it possible that the exposure to the virus happened between 2021 and 2025? Is there a chance that my anti-HBs in 2017 waned to an unprotected level up until 2021?
Hi @Tom,
Great question. My guess is that between 2017-2025, some exposure happened. Exactly when, that is hard to tell.
These things can be complicated especially when trying to nail down an exact timing of things. I am glad you have strong protection against HBV.
Best, Bansah1
Hi Tom
I think that some of your HBV profiles especially high anti HBs titer(> 1,000 mIU/ ml) means that you have immunity to HBV from past infection like @ Bansah suggests.
Standard HBV screening tests need triple panel. ( HBsAg, anti HBs , anti HBc ) as US CDC recommended, however, in low to middle income countries(LMIC) which are resource limited settings , most often screen using only HBsAg alone.
If HBsAg screening was +ve , then it was further confirmed with machine based-laboratory tests.
If HBsAg screening was -ve , then the antiHBs(qualitative) will be tested, and if the result was -ve then the HBV vaccine will be administered. anti HBc will not be tested in screening due to it require machine based laboratory test that is expensive and less cost- effectiveness in clinical practice.
Currently, the laboratory tests standard of blood bank for HBV as far as I know are screening with anti HBc along with HBsAg for every blood donors. If HBsAg or anti HBc were + ve , the blood bank will reject donors for transfusion. There is also highly sensitive test for detect.HBV like nucleic acid test (NAT)
which allowed HBV DNA to be detected even with small number. You have had a past with HBV infection (anti HBc +ve) and have now resolved and developed immunity (antiHBs +ve ), so that is very little chance of transmission to others unless it is the case of occult HBV infection (OBI) where the blood test will show HBsAg-ve , antiHBc +ve and there will have some amount of HBV DNA(usually < 200 IU/ml) in bloodstream which can be detected with NAT laboratory test.
HBV vaccine made from HBsAg protein that are given in normal healthy people , the blood test will be detected only anti HBs alone and anti HBc will be -ve .
In 2017, if your immunity (anti HBs) was due to vaccine administered in 2010, then anti HBs will protect HBV infection and consequently anti HBc will not occur in your blood . However, in March 2025 , your blood test for antiHBc +ve which suggest that you had past HBV infection before 2010 . So , it is impossible.for HBV infection between 2021-2025 due to you anti HBs +ve . The level of anti HBs is likely to decrease or waning over time, however, your anti HBs will still be detectable over a period of four years (2017-2021) because the antibody level is very high (> 1000 mIU/ ml) .
I hope that this may help you understand your HBV status.
chul_chan
Chulapong Chanta MD. Pediatric
Dear @Tom,
We have to be careful about the use of “protective” when we are talking about anti-HBs results. In the context of someone who has never been infected (HBcAb IgG and IgM negative) who has then has subsequently had vaccination, we know that the anti-HBs in this scenario is protective.
In the context of someone who has been infected (HBcAb IgG positve) and who has developed an anti-HBs result, it is very unlikely that the anti-HBs that is present comes from one of the approved vaccines on the market (such as in your case). There is also no data that shows that anti-HBs produced after chronic infection has been established has any neutralizing effects in humans - rather there is good clinical data which shows that the appearance of anti-HBs does not predict nor is required for functional cure of HBV.
What we do know is that the only way for anti-HBs to become detectable and to persist after functional has been established is for HBsAg production from the liver to be brought completely under control (which is the fundamental aspect of functional cure which is so important).
In your case, the most likely scenario is that you achieved functional cure of HBV after you became chronic or self resolved your acute HBV infection to functional cure. In both cases you would have had no symptoms so no reason to think you had been infected. You likely had anti-HBs BEFORE you were vaccinated (usually there is no screening before vaccination).
The good news is that you have HBV functional cure (which is as good as it gets). Slow decline of anti-HBs over time is normal (since there is no antigen present). Many people have established HBV functional cure without having detectable anti-HBs.
@Bansah1
It is really hard to tell when I was exposed. Thank you so much for your feedback.
@chul_chan
Hi Dr. Chanta, thank you so much for your comment and clear explanation.
Back in my country, only HBsAg test is required for Hepatitis B screening. I never tested for triple panel as you mentioned. I am convinced now that my past infection probably happened before my vaccination in 2010. But what about my blood donation in August 2021? I don’t have any idea if the blood bank tested me for anti-HBc. Is it possible that they just tested for HBsAg and HBV DNA/NAT and then released my donated blood even without anti-HBC test? Unfortunately, I don’t have the result of the blood test in 2021. Maybe I will follow up with the blood bank and ask them if they can retrieve my blood test results from my first donation. However, if I tested negative for anti-HBc in 2021, it is likely that my infection happened from 2021 onwards. Or do false positive anti-HBc still occur?
Regarding OBI Doc, do I need to go to a hepatologist to get checked and ask for lab request for HBV DNA? I have only the triple panel which is HBsAg (-) official result still at the blood bank, anti-HBs (titer) 712 and anti-HBc (+). Having anti-HBs, can we still suspect OBI? Thanks a lot.
@availlant
Thank you for explaining further. I just worry so much about my HBV status. Honestly, I am anxious about my HBV status (anti-HBc positive) and deferral from donating in the future.
I don’t quite understand your explanation about anti-HBs. You mean even without the presence of anti-HBs, only anti-HBc alone, we can consider someone as functional cure?
Another, about the neutralizing effect of anti-HBs (from infection). Meaning the function or the effect of anti-HBs from the vaccine and the anti-HBs from infection is not similar? Thank you.
Hi @Tom ,
Testing for HBcAg antibodies tells us if some one has ever been infected. These antibodies are reacting to the protein shell within the virus which contains its genetic information. They do not provide any other diagnostic information.
People who are vaccinated before being exposed to the virus do not develop detectable HBcAg antibodies. So you were infected prior to vaccination but also very likely achieved functional cure before vaccination and thus already had HBsAg antibodies before you were vaccinated.
People who are vaccinated after being infected do not produce HBsAg antibodies.
HBV functional cure occurs when someone does not have any detectable viral DNA or HBsAg in their blood in the absence of antiviral therapy. Although the presence of HBsAg antibodies is not required for functional cure, the high levels of anti-HBs can only occur if you have achieved functional cure.
To ease your mind, please consult your doctor to have your HBV DNA and HBsAg checked as well as your liver function. These will prove definitively that you have functional cure. You will lot be able to give blood again but you will live a long and healthy life. I highly doubt you have occult infection.
The important distinction regarding anti-HBs is not the anti-HBs itself but the nature of the HBsAg it is targeting. HBV infection when chronic develops a substantial genetic diversity which allows HBsAg to evolve to escape detection by anti-HBs either when produced by the body or stimulated by vaccination.
Hi Tom
The occurrence of false positive rate of anti HBc is about 1:500 which quite uncommon occur in clinical practice and you have concomitant anti HBs +ve , however, if we suspect about false positive result we can repeat another different anti HBc lab to confirm.
From one study (Allain JP et al , Transfusion 2013 ) , it was found that transmission of HBV from blood donors was limited to antiHBc +ve donors with low level of anti HBs (< 100 mIU/ml) . So your anti HBc +ve with high level of anti HBs may be considered safe for transfusion by blood bank especially in rare blood donors groups.
Mostly, seropositive OBI (HBsAg -ve, anti HBs +ve, , anti HBc +ve ) have low level of anti HBs , so your HBV status is most likely compatible with past resolved HBV infection. Hence, you don’t need to follow on the blood test results from blood bank since it doesn’t change your HBV status. I hope this may help you .
chul_chan
Chulapong Chanta MD. Pediatric
@Bansah1 @chul_chan @availlant
Hi there again,
Thank you so much for answering all my queries. I truly appreciate your health advice and your explanation about my hbv status.
Followed up with the blood bank today. Retrieved my old blood test results. They did not check for anti-HBc during my 1st donation (Aug. 2021). They checked only for HBsAg and HBV DNA. You’re right Doc.
Below are the latest results of my 2nd donation (March 2025) initial and repeat tests. They did check for anti-HBc because of my high ALT result. I have my Hep B full panel and they also confirmed that the past exposure happened before my vaccination. I couldn’t hold back my tears after they handed me my results and its interpretation. Yeah it doesn’t change my HBV status but at least after more than a decade my HBV resolved status is now known to me. My focus now is to take good care not only my liver but also my entire health. I know I am weak handling this situation since these results are just fresh to me. Soon I’ll be okay. Again, thank you for your time and effort to comment down.
Dear @Tom,
Yes you definitely had achieved functional cure prior to your first vaccination. But no harm done by receiving the vaccine anyways.
Mildly elevated ALT is caused by something else:
too much alcohol
too many carbohydrates in your diet
consistent strenuous exercise (in this case ALT elvation is not really a concern)
Hi @Tom,
This is an issue I have spoken out against many times. Your case seems to happen to many patients. We are given a false sense of security when they only screen for HBsAb for employment and other purposes. If you test negative, you receive the vaccine, and you feel great, thinking you are somehow protected. But then, some years later, you are tested for HBsAg and it’s positive, then the confusion and panic set in.
That is exactly what happened to me. Nobody tested me for HBsAg, but every hepatitis B test I did was for the surface antibody. I remember getting vaccinated during my immigration process, then my work in the health field, and the military. I didn’t know much about HBV at the time, so I never asked any questions or gave anything a deeper thought. But I was already chronically infected as I came to find out in 2014, and realized I didn’t need all these vaccinations. I have been living under the false security of being protected all those years. I hope this policy changes and people are tested for the triple panel, including HBsAg, even for work.
It’s challenging and painful to get that sense of security shattered because some tests were not conducted to get a clear picture of one’s status.
I hope as you said you can adapt to this news and keep moving forward. We are here and will support you in the process. Take it one step at a time. If there’s anything positive, it’s the fact that you cleared the virus and developed antibodies against it. Keep us posted on how you are doing or feeling. Best, Bansah1