hepatitis b virus infection in an anti-hbc negative patient: a case report

abstract one of the best reliable markers of hepatitis b virus infection is antibodies to the core antigen (anti-hbc). a first-time blood donor with hbsag positivity was identified as an hbv carrier that was anti-hbc negative. the patient was followed for 24 months in order to investigate the evolution of his hbv serological profiles and hbvdna (pcr). in the follow-up for 24 months, hbsag, hbeag and hbv-dna (pcr) were positive but all the time anti-hbc remained negative. hbv dna viral load was 3.4×106 copies per ml. in the immunohistochemical study on the needle liver biopsy, the hepatocytes were positive for hbcag and hbsag. for this immunological situation, the most probable hypothesis is an immunotolerance to hbv due to an in utero hbv infection. this situation does not impose a risk of hbv transmission by blood transfusion, because hbsag positive donations are excluded and discarded by hbsag screening tests.