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Vitamin D insufficiency evident in patients with untreated chronic HBV

Levels of vitamin D among patients with chronic hepatitis B virus infection were extremely low and prevalent when the infection was left untreated. The low levels were, however, not associated with treatment outcomes.

“To our knowledge, this is the largest analysis of vitamin D levels among patients with [chronic HBV],” Henry Lik-Yuen Chan, MD, Prince of Wales Hospital, The Chinese University of Hong Kong, and colleagues wrote. “The analysis also comprises a board global sampling from 139 sites in Europe, Asia, North America, Australia and India.”

Henry Lik-Yuen Chan

The researchers randomly assigned 740 patients to either a dosage of tenofovir disoproxil fumarate (TDF) plus pegylated interferon alfa-2a  for 48 weeks, TDF plus PEG-IFN a-2a for 16 weeks followed by TDF for 32 weeks, PEG-IFN a-2a for 48 weeks, or TDF for 120 weeks.

The primary outcome was to determine associations between vitamin D, baseline factors, and week 48 clinical outcomes. Insufficient levels were deemed to be greater than 20 ng/mL and less than 31 ng/mL and deficient levels were considered to be less than 20 ng/mL.

Overall, 7% had normal vitamin D levels, 35% had insufficient and 58% had deficient levels out of 737 included patients.

In univariate analysis, lower vitamin D levels were associated with younger age, lower uric acid levels, a positive hepatitis B e antigen (HBeAg) status, lower calcium levels, blood drawn in winter or autumn and HBV genotype D. In multivariate analysis, HBV genotype, season of blood drawn, calcium level and age remained associated with lower vitamin D levels.

High baseline level of vitamin D was associated with low HBV DNA, normal alanine aminotransferase serum level and hepatitis B surface antigen positivity at 48 weeks. However, this association was no longer significant after adjusting for age, gender, HBeAg and HBV genotype, with the exception of ALT.

“Although the effect of vitamin D on virologic treatment outcomes were largely confounded by different clinical and virologic factors in this study, whether a low vitamin D level contributes to unsuccessful immune clearance and active hepatitis warrants further study,” the researchers concluded.

Disclosure: Chan reports advising and speaking for AbbVie, Bristol-Myers Squibb, Gilead Sciences, Roche, MSD and Novartis; serving as a speaker for GlaxoSmithKline and Echosens; and receiving unrestricted grants for HBV research from Roche. Please see the full study for a list of all other authors’ relevant financial disclosures.