A blood donor is found to have the following hepatitis B profile: HBsAg negative, anti-HBs negative, total anti-HBc positive, anti-HBc IgM negative, and HBV DNA undetectable by PCR. The most likely explanation is:

• A Early acute hepatitis B in the window period
• B Response to hepatitis B vaccination
• C Chronic low-level carrier state
• D Resolved hepatitis B in which anti-HBs has waned over time ✓

Explanation

Isolated total anti-HBc positivity with undetectable HBV DNA most often represents remote resolved infection in which anti-HBs titres have fallen below detectable levels while anti-HBc IgG persists lifelong. The negative IgM rules out recent infection, so the window period is excluded. A chronic carrier would be HBsAg positive, and a vaccine responder would show anti-HBs alone without anti-HBc.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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Written and medically reviewed by the StethoPrep medical team.