title: Association of vitamin D deficiency with hepatitis B virus - related liver diseases.
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.
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Nghiem Xuan
authors.initials: NX
authors.lastname: Hoan
authors.affiliation: Department of Infectious Diseases, Duc Giang Hospital, Hanoi, Vietnam.
authors.forename: Nguyen
authors.initials: N
authors.lastname: Khuyen
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Mai Thanh
authors.initials: MT
authors.lastname: Binh
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Dao Phuong
authors.initials: DP
authors.lastname: Giang
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Hoang
authors.initials: H
authors.lastname: Van Tong
authors.affiliation: Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
authors.forename: Phan Quoc
authors.initials: PQ
authors.lastname: Hoan
authors.affiliation: Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.|Department of Molecular Biology, 108 Military Central Hospital, Hanoi, Vietnam.
authors.forename: Ngo Tat
authors.initials: NT
authors.lastname: Trung
authors.affiliation: Department of Infectious Diseases, Vietnam Military Medical University, Hanoi, Vietnam.
authors.forename: Do Tuan
authors.initials: DT
authors.lastname: Anh
authors.affiliation: Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.|Department of Pathophysiology, Vietnam Military Medical University, Hanoi, Vietnam.
authors.forename: Nguyen Linh
authors.initials: NL
authors.lastname: Toan
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Christian G
authors.initials: CG
authors.lastname: Meyer
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Kremsner
authors.affiliation: Institute of Tropical Medicine, University of Tübingen, Tübingen, Germany.|Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam.|Fondation Congolaise pour la Recherche Medicale, Brazzaville, Republic of Congo.
authors.forename: Thirumalaisamy P
authors.initials: TP
authors.lastname: Velavan
authors.affiliation: Vietnamese-German Center for Medical Research (VG-CARE), Hanoi, Vietnam. lehuusong@108-icid.com.|Institute of Clinical Infectious Diseases, 108 Military Central Hospital, Tran Hung Dao Street N1, Hai Ba Trung District, Hanoi, Vietnam. lehuusong@108-icid.com.
authors.forename: Le Huu
authors.initials: LH
authors.lastname: Song
keywords: Chronic liver disease; HBV infection; Hepatocellular carcinoma; Liver cirrhosis; Vitamin D deficiency