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. 2016 Sep 23;16(1):507.
doi: 10.1186/s12879-016-1836-0.

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

Nghiem Xuan Hoan  1   2 , Nguyen Khuyen  3 , Mai Thanh Binh  1   2 , Dao Phuong Giang  1   2 , Hoang Van Tong  1   2 , Phan Quoc Hoan  4 , Ngo Tat Trung  2   4 , Do Tuan Anh  5 , Nguyen Linh Toan  2   6 , Christian G Meyer  1   2 , Peter G Kremsner  1   2 , Thirumalaisamy P Velavan  1   2   7 , Le Huu Song  8   9
Affiliations

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

Nghiem Xuan Hoan et al. BMC Infect Dis. .

Abstract

Background: As 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.

Methods: We 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.

Results: The 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).

Conclusions: Vitamin 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.

Keywords: Chronic liver disease; HBV infection; Hepatocellular carcinoma; Liver cirrhosis; Vitamin D deficiency.

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Figures

Fig. 1
Fig. 1
Vitamin D levels in healthy individuals (HC), HBV patients and subgroups. Chronic hepatitis B (CHB), liver cirrhosis (LC) and hepatocellular carcinoma (HCC); P values were calculated by Mann-Whitney Wilcoxon test
Fig. 2
Fig. 2
Distribution of vitamin D levels in HBV related liver cirrhosis patients. a Vitamin D levels in different stages of HBV-related liver cirrhosis according to Child-Pugh classification. b Vitamin D levels in different stages of HBV-related liver cirrhosis. Dot-plots illustrate medians with interquartile ranges. P values were calculated by Mann-Whitney-Wilcoxon test
Fig. 3
Fig. 3
Correlation between Vitamin D levels with HBV-DNA loads. The correlation between vitamin D levels and HBV-DNA loads in chronic hepatitis B patients was calculated by using Spearman’s rank correlation coefficient. Spearman’s rho (rho) and P value are given
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