Association of vitamin D deficiency with hepatitis B virus - related liver diseases

Abstract

BackgroundAs an immune modulator, vitamin D is involved in various pathophysiological mechanisms in a plethora of diseases. This study aims to correlate the vitamin D deficiency status and clinical progression of liver diseases associated with hepatitis B virus (HBV) infection in patients in Vietnam and to compare it to healthy controls.MethodsWe quantified the levels of total vitamin D [25-(OH) D2 and D3] in serum samples from 400 HBV patients (chronic hepatitis B infection [CHB], n = 165; HBV-associated liver cirrhosis [LC], n = 127; HBV-associated hepatocellular carcinoma [HCC], n = 108) and 122 unrelated healthy controls (HC). Univariate and multivariate analyses were performed in order to determine the association between vitamin D levels and distinct clinical parameters.ResultsThe prevalence of vitamin D inadequacy (<30 ng/mL) was high among healthy individuals (81.7 %) as well as in HBV patients (84.3 %). Vitamin D deficiency (<20 ng/ml) or severe deficiency (<10 ng/ml) was observed more frequently among HBV patients (52 %) and subgroups (CHB, 47.8 %; LC, 54.4 %; HCC, 55.3 %) compared to the control group (32.5 %) (P < 0.001). Vitamin D levels and HBV-DNA load were strongly and inversely correlated (rho = −0.57, P < 0.0001). Multivariate regression analysis also revealed an independent association of HBV-DNA loads with low vitamin D levels (P = 0.0004). In addition, reduced vitamin D levels were associated with significant clinical progression of LC (Child-Pugh C versus Child-Pugh A, P = 0.0018; Child-Pugh C versus Child-Pugh B, P = 0.016).ConclusionsVitamin D deficiency was observed in the majority of HBV-infected patients and associated with adverse clinical outcomes. Our findings suggest that substitution of vitamin D may be a supportive option in the treatment of chronic liver diseases, in particular of HBV-associated disorders.

Controversial Effects of Vitamin D and Related Genes on Viral Infections, Pathogenesis, and Treatment Outcomes

“…The 25(OH)D 3 plasma level showed a significant inverse correlation with plasma HBV DNA loads and a positive correlation with the seroclearance of the hepatitis B surface antigen (HBsAg) [115,116] (Table 3). In turn, reduced VD levels were associated with the clinical progression of liver cirrhosis and adverse clinical outcomes [117]. In line with this clinical evidence, the downregulation of VDR expression in HBV-transfected cells caused an increase in HBV transcription and translation [118].…”

VDR rs7975232/ApaI genetic variation predicts sustained HBsAg loss in HBeAg‐positive chronic hepatitis B patients treated with pegylated interferon

“…Vitamin D levels were found significantly lower in CHB patients than healthy controls, and low‐serum vitamin D levels were associated with high levels of HBV viral load or Child‐Pugh score . Low‐serum vitamin D level at baseline might mean a poor clinical outcome in CHB patients, and some scholars suggested that vitamin D supplement therapy could be tried on these patients. But some research showed contradictive results .…”

Serum vitamin D levels in treatment-naïve chronic hepatitis B patients

“…Yet, Hoan and his colleagues described more frequent vitamin D deficiency in post HBV cirrhotic patients and those with HBV related HCC than those with chronic active hepatitis. [16] Patients with positive HBeAg were not included in this study, but few studies reported more reduction in vitamin D levels in patients with positive HBeAg than those who were negative. [7,17] In our study, although vitamin D levels had a strong negative correlation with HBV DNA levels, yet it did not show any correlation with the degree of necroinflammation represented by AST, ALT levels, in contradiction to some studies.…”