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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.

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