AIM: To investigate the prevalence and clinical significance of anti-HBc alone in an unselected population of patients and employees of a university hospital in south Germany.METHODS: All individuals with the patt anti-HBc alone were registered over a time span of 82 mo. HBV-DNA was measured in serum and liver samples, and clinical charts were reviewed.RESULTS: Five hundred and fifty two individuals were anti-HBc alone (of 3004 anti-HBc positive individuals;18.4%), and this patt affected males (20.5%) more often than females (15.3%; P＜ 0.001). HBV-DNA was detected in serum of 44 of 545 anti-HBc alone individuals (8.1%), and in paraffin embedded liver tissue in 16of 39 patients tested (41.0%). There was no association between the detection of HBV genomes and the presence of biochemical, ultrasonic or histological signs of liver damage. Thirty-eight anti-HBc alone patients with cirrhosis or primary liver carcinoma had at least one additional risk factor. HCV-coinfection was present in 20.4%of all individuals with anti-HBc alone and was the only factor associated with a worse clinical outcome.CONCLUSION: In an HBV low prevalence area, no evidence is found that HBV alone causes severe liver damage in individuals with anti-HBc alone. Recommendations for the management of these individuals are given.