title: Low vitamin D serum concentration is associated with high levels of hepatitis B virus replication in chronically infected patients.
abstract: 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)D3 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)D3 <10 ng/mL), vitamin D insufficiency (25(OH)D3 ≥10 and <20 ng/mL), or adequate vitamin D serum levels (25(OH)D3 ≥20 ng/mL), respectively. In both uni- and multivariate analyses, HBV DNA viral load (log10 IU/mL) was a strong predictor of low 25(OH)D3 serum levels (P = 0.0007 and P = 0.000048, respectively) and vice versa. Mean 25(OH)D3 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)D3 serum levels than HBeAg-negative patients (P = 0.0013). Finally, 25(OH)D3 and HBV DNA serum levels showed inverse seasonal fluctuations.
  
  
  CONCLUSIONS
  Low 25(OH)D3 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)D3 and HBV DNA serum levels are suggestive of a functional relationship between both variables.
authors.affiliation: Medizinische Klinik 1, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt, Frankfurt, Germany.
authors.forename: Harald
authors.initials: H
authors.lastname: Farnik
authors.forename: Jörg
authors.initials: J
authors.lastname: Bojunga
authors.forename: Annemarie
authors.initials: A
authors.lastname: Berger
authors.forename: Regina
authors.initials: R
authors.lastname: Allwinn
authors.forename: Oliver
authors.initials: O
authors.lastname: Waidmann
authors.forename: Bernd
authors.initials: B
authors.lastname: Kronenberger
authors.forename: Oliver T
authors.initials: OT
authors.lastname: Keppler
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.forename: Christoph
authors.initials: C
authors.lastname: Sarrazin
authors.forename: Christian M
authors.initials: CM
authors.lastname: Lange
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D004279:DNA, Viral / Q000097:blood; D005260:Female; D006515:Hepatitis B virus / Q000235:genetics / Q000502:physiology*; D019694:Hepatitis B, Chronic / Q000097:blood / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019562:Viral Load / Q000502:physiology; D014779:Virus Replication / Q000502:physiology*; D014807:Vitamin D / Q000097:blood*
chemical_list: D000998:Antiviral Agents; D015415:Biomarkers; D004279:DNA, Viral; D014807:Vitamin D