The presence of anti-HBc (total) with a negative HBsAg and a negative anti-HBs indicates one of the following four things:
The patient is in a window of acute hepatitis between the elimination of HBsAg and the appearance of anti-HBs; this scenario is not observed in patients with chronic HBV infection
The patient has cleared HBV but has lost anti-HBs over the years
The patient is one of the uncommon individuals with active HBV replication who is negative for HBsAg; this situation is diagnosed when either a positive HBeAg or a positive HBV DNA result is found