I think some of them are an occult blood but not all of them. In the past when we couldn't check the HBV DNA Vial Load some of my patients with HBsAg negative, Anti-HBc Ab positive and Anti HBs negative had good response to hepatitis B vaccine so it is better check the HBV DNA Viral Load before any decision but it is not necessarily.

This isolated anti-HBc +ve patients could be divided in two separated categories. 1. Low levels of anti-HBs (>98% of cases). These cases should be(or could be) vaccinated.. 2. Occult HBV infection(1-2% of cases) with HBV DNA didectable. In these cases vaccination is useless.

I agree with Dr Themistoklis Vasileiadis , but unfortunately the hemodialysis patients are not good cases for response to HBV vaccine.

Only the serological findings at one point isn't sufficient for a diagnosis.

You constellation shows only, that the patient had a contact with this virus (and not with the vaccine). In some patients you never see any immune response versus the HBsAg, also not in all vaccinated.

The current status could be:

1. restitutio ad integrum (healed)

2. chronic persisting hepatitis (with / without viremia)

3. occult hepatitis (occult means mainly the it's very difficult to detect this form. The patients are infective but sometimes negative even in all serological tests and even sometimes in NAT). Clinically signs of a chronic persistent hepatitis can/may be found.

To make sure, you need to see the patient at several appointments. Search for other lab and clinical signs of a hepatitis: ALAT, ASAT, gamma-GT, bilirubin and it's derivatives, liver biopsy, ultrasound, ... and the HBV-NAT, .

About the vaccinations: Two opinions:

1. It's could be helpful to get additional immune stimulation to fight the potential residual virus. But I haven't seen any clinical trials answering this question

2. There could be a risk for enhancement by the induced antibodies. It's described for other viruses, but again: I haven't seen any clinical trial. If you are thinking about the virus, just before virus assembling HBsAg is on the surface of the liver cell. From the "normal clinical" course of thev infection is known, that IgM-antibodies against HBsAg can be in severe cases responsible for the massive destruction of the liver cells. The later immune response is T cell driven.

For patients with isolated anti-HBc Ab did you check for HIV or HCV co infection?

I check both HIV and HCV ab and HBV DNa for isolated anti-HBc Ab positive cases

it completely depends on the situation of patients. for general population, nothing. for any other abnormal situation like: immunosuppressive therapy, transplantation,dialysis, even health care workers, etc, all need different management. in these situation I would recommend a repeated serology by third or forth generation EIA, viral load and rule out the coinfection. of course I would recommend a full dose vaccine in these abnormal conditions together with anti-HBs checking to make sure it does work.

Dear colleague

First of all you should consider the frequency of discrete antihbc case and condition in which antihbc should positive . Regard to molecular evaluation if indicated viral load is not suitable and other molecular sensitive approved test must be considered.

Which sensitive tests?