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Anti Hepatitis B Core Antibody (AHBc) - Total
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The Anti-HBc Total test detects both IgM and IgG antibodies to the core antigen (HBcAg) of the Hepatitis B virus (HBV).
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Anti Hepatitis B Core Antibody (AHBc) - Total
- Why is it done?
- Test Measurement: This test detects antibodies against the hepatitis B core antigen (HBcAg), indicating current or past exposure to hepatitis B virus (HBV). The total anti-HBc includes both IgM and IgG antibodies.
- Screening for Hepatitis B Infection: To identify individuals with active hepatitis B or those who have recovered from HBV infection
- Blood Donor Screening: Required screening for all blood and plasma donors to prevent transmission of hepatitis B through transfusion
- Pre-vaccination Assessment: To determine baseline immunity status and document evidence of previous HBV infection before hepatitis B vaccination
- Occupational Health Screening: For healthcare workers, laboratory personnel, and others at risk of blood-borne pathogen exposure
- Investigation of Liver Disease: When evaluating patients with unexplained hepatitis, elevated liver enzymes, or acute liver failure
- Contact Tracing: To identify exposure in household contacts, sexual partners, or occupational contacts of hepatitis B positive individuals
- Immigration and Travel Requirements: As mandated by some countries or organizations for visa processing or entry requirements
- Normal Range
- Reference Values: Negative (usually reported as <0.9 to 1.0 mIU/mL or simply 'Negative' depending on assay methodology)
- Units of Measurement: Reported qualitatively as positive or negative; some laboratories report quantitatively as index values or ratios (typically 0.0-1.0 is negative, >1.0 is positive)
- Negative Result: No antibody to hepatitis B core antigen detected - indicates no evidence of HBV infection (assuming negative surface antigen and negative surface antibody)
- Positive Result: Antibody to hepatitis B core antigen detected - indicates current or past HBV infection; requires further testing with HBsAg and anti-HBs to determine infection status
- Borderline/Equivocal: Some laboratories report values in a gray zone requiring repeat testing or reflexive testing with additional markers
- Interpretation
- Positive Anti-HBc with Positive HBsAg: Indicates current active hepatitis B infection. Patient has detectable HBV and is infectious. Further evaluation needed including HBe antigen/antibody, HBV DNA level, and liver function tests.
- Positive Anti-HBc with Negative HBsAg and Positive Anti-HBs: Indicates past HBV infection with recovery and immunity. Patient is immune and generally not infectious. This is the typical pattern in vaccinated individuals (anti-HBs positive only).
- Positive Anti-HBc with Negative HBsAg and Negative Anti-HBs (Occult Infection): Indicates past or resolved HBV infection with low/absent surface markers. May still transmit virus to others. Requires HBV DNA testing and close monitoring.
- Negative Anti-HBc with All Other Markers Negative: No evidence of HBV infection. Patient is susceptible to HBV infection and should be offered hepatitis B vaccination if indicated.
- IgM Anti-HBc Positive: Indicates acute hepatitis B infection. This antibody appears early in infection (within 1-2 weeks) and typically persists for 6 months. Helps differentiate acute from chronic infection.
- IgG Anti-HBc Positive: Indicates past or chronic infection. Persists for life after HBV infection and aids in distinguishing infection from vaccination.
- Factors Affecting Results: Window period (3-6 weeks after infection when HBsAg negative but anti-HBc positive), immunosuppression may cause false negatives, laboratory methodology variations, and sample handling.
- Associated Organs
- Primary Organ System: Hepatic (Liver) - The liver is the primary target organ for hepatitis B virus infection and replication.
- Acute Hepatitis B: Presents with acute hepatitis, characterized by inflammation of liver tissue, elevated transaminases (ALT, AST), jaundice, dark urine, pale stools, and abdominal discomfort. Usually self-limited in adults with 85-90% recovery rate.
- Chronic Hepatitis B: Develops in 5-10% of infected adults (higher rates in neonates and children). Results in persistent HBV replication, chronic inflammation, and progressive liver fibrosis.
- Cirrhosis: Chronic HBV infection can lead to hepatic cirrhosis with portal hypertension, ascites, varices, and hepatic encephalopathy. Associated with increased mortality risk.
- Hepatocellular Carcinoma (HCC): Chronic HBV is a major risk factor for development of primary liver cancer. Risk increases with duration and severity of chronic infection.
- Fulminant Hepatic Failure: Rare but serious complication with acute massive hepatic necrosis, coagulopathy, hepatic encephalopathy, and high mortality rate without transplantation.
- Extrahepatic Manifestations: Immune complex-mediated conditions including polyarthralgias, arthritis, glomerulonephritis, vasculitis, and cryoglobulinemia can occur.
- Renal Complications: Membranous nephropathy and other immune-complex glomerulonephritis patterns can develop, potentially leading to chronic kidney disease.
- Follow-up Tests
- Hepatitis B Surface Antigen (HBsAg): Essential reflexive test to determine if infection is current or past. Positive indicates active/current infection.
- Hepatitis B Surface Antibody (Anti-HBs): Indicates immunity from past infection or vaccination. Combined interpretation with anti-HBc and HBsAg determines infection status.
- IgM Anti-HBc: Recommended when acute hepatitis B infection is suspected to differentiate from chronic or past infection.
- Hepatitis B e Antigen (HBeAg) and Hepatitis B e Antibody (Anti-HBe): Markers of viral replication and infectivity. HBeAg positive indicates high viral load and increased transmission risk.
- HBV DNA (Quantitative PCR): Viral load testing to assess degree of viral replication. Essential for monitoring treatment response and determining need for antiviral therapy.
- Liver Function Tests (AST, ALT, ALP, Bilirubin, Albumin): Assess degree of liver inflammation and synthetic function. Important for staging disease severity.
- Platelet Count and Prothrombin Time (PT/INR): Evaluate hepatic synthetic function and screen for cirrhosis or advanced fibrosis.
- Hepatitis D (Delta) Antibody and Antigen: Testing recommended in HBsAg-positive patients, as HDV can only infect those with HBV, complicating disease.
- Hepatitis A and C Serologies: Screen for concurrent infections that increase risk of severe hepatic disease in HBV-positive individuals.
- Liver Ultrasound/Elastography: Assess for cirrhosis, portal hypertension, and hepatocellular carcinoma in chronic HBV patients.
- FIB-4 Index and APRI Score: Non-invasive markers of liver fibrosis using routine laboratory values for risk stratification.
- HIV and Syphilis Serology: Recommended for all HBsAg-positive patients to screen for co-infections that impact management.
- Monitoring Frequency: HBsAg-positive patients require periodic testing including HBV DNA, liver function tests, and imaging depending on disease stage (typically annually for stable disease, more frequently for HBeAg-positive or treatment-requiring disease).
- Anti-HBc Positive/HBsAg Negative: May require HBV DNA testing (ultra-sensitive PCR) if concerned about occult infection, particularly in immunocompromised patients or before immunosuppressive therapy.
- Fasting Required?
- Fasting Requirement: NO - Fasting is not required for this test
- Sample Collection: Simple blood draw via venipuncture into standard serum separator tubes (SST) or EDTA tubes depending on laboratory protocol.
- Timing Considerations: Test can be performed at any time of day. No specific time-of-day effects on anti-HBc results.
- Medications: No medications need to be held or avoided. No interference from common medications with anti-HBc testing.
- Patient Preparation: Normal routine can be maintained. No special dietary restrictions, fluid restrictions, or activity limitations required.
- Sample Stability: Serum samples should be refrigerated if not processed immediately. Samples are generally stable for 5-7 days at 2-8°C before testing.
- Additional Considerations: For window period testing (acute HBV suspicion), timing is important - test should be performed 3-6 weeks after potential exposure if HBsAg remains negative. For vaccination response assessment, test can be done 4-6 weeks after last vaccine dose.
How our test process works!
