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Low vitamin D levels prevalent in untreated patients with HBV

In a new study, researchers found that untreated patients with chronic hepatitis B virus infection had significantly low levels of vitamin D.

“Given the paucity of information on the role of vitamin D in [chronic hepatitis B], along with recent data suggesting vitamin D may contribute to interferon-stimulated gene expression, we evaluated the baseline serum vitamin D levels and their association with baseline clinical parameters and clinical outcomes among a large population of patients with treatment-eligible [chronic hepatitis B] infection,” the researchers wrote.

Researchers, including Henry Lik-Yuen Chan, MD, of Prince of Wales Hospital in Hong Kong, randomly assigned 740 patients with chronic HBV without advanced liver disease to either 48 weeks of tenofovir disoproxil fumarate (TDF) plus pegylated interferon alfa-2a (PEG-IFN alfa-2a); TDF plus PEG-IFN alfa-2a for 16 weeks followed by TDF for 32 weeks; PEG-IFN alfa-2a for 48 weeks; or TDF for 120 weeks. Fifty-eight percent of the cohort were positive for hepatitis B e antigen (HBeAg); 66% were male; and were all randomly assigned therapy at 139 clinical sites.

The primary outcome was to determine associations between vitamin D, baseline factors, and week 48 clinical outcome, according to the researchers.

Of 737 patients in the final analysis, 58% had deficient levels (less than 20 ng/mL) of vitamin D, and 35% had insufficient levels (at least 20 ng/mL but less than 31 ng/mL) of vitamin D.

Younger age, lower uric acid levels, HBeAg-positive status, lower calcium levels, blood drawn in winter or autumn and HBV genotype D to be baseline parameters were associated with lower vitamin D levels, according to the univariate analysis. In contrast, multivariate analysis only showed HBV genotype, season of blood drawn, calcium level and age as associated parameters.

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

“Low baseline vitamin D level was associated with lower baseline ALT level and a lower tendency to normalize ALT after 48 weeks of treatment,” the investigators wrote. “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.” – by Melinda Stevens

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.