Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients

Vitamin D is an important immune modulator that plays an emerging role in inflammatory and metabolic liver diseases, including infection with hepatitis C virus (HCV). In contrast, the relationship between vitamin D metabolism and chronic hepatitis B (CHB) is less well characterized. Therefore, we quantified 25(OH)D 3 serum levels in a cohort of 203 treatment‐naïve patients with chronic hepatitis B virus (HBV) infection and tested for their association with clinical parameters of CHB. Of 203 patients, 69 (34%), 95 (47%), and 39 (19%) had severe vitamin D deficiency (25(OH)D 3 <10 ng/mL), vitamin D insufficiency (25(OH)D 3 ≥10 and <20 ng/mL), or adequate vitamin D serum levels (25(OH)D 3 ≥20 ng/mL), respectively. In both uni‐ and multivariate analyses, HBV DNA viral load (log 10 IU/mL) was a strong predictor of low 25(OH)D 3 serum levels ( P  = 0.0007 and P  = 0.000048, respectively) and vice versa. Mean 25(OH)D 3 serum concentrations in patients with HBV DNA <2,000 versus ≥2,000 IU/mL were 17 versus 11 ng/mL, respectively ( P  < 0.00001). In addition, hepatitis B early antigen (HBeAg)‐positive patients had lower 25(OH)D 3 serum levels than HBeAg‐negative patients ( P  = 0.0013). Finally, 25(OH)D 3 and HBV DNA serum levels showed inverse seasonal fluctuations. Conclusion : Low 25(OH)D 3 serum levels are associated with high levels of HBV replication in patients with CHB. This represents a major difference from chronic hepatitis C, where numerous previous studies have shown a lack of correlation between HCV viral load and vitamin D serum levels. Inverse seasonal fluctuations of 25(OH)D 3 and HBV DNA serum levels are suggestive of a functional relationship between both variables. (H epatology 2013;58:1270–1276)