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      The prevalence and severity of 25-(OH)-vitamin D insufficiency in HCV infected and in HBV infected patients: a prospective study

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          Abstract

          Aim of the study

          To assess the prevalence and severity of vitamin D insufficiency in patients with hepatitis C virus (HCV) infection and in patients with hepatitis B virus (HBV) infection.

          Material and methods

          This prospective study included 90 patients with chronic hepatitis C and 35 patients with chronic hepatitis B admitted to the Infectious Diseases Department between March 2013 and May 2014. Patients with chronic liver disease other than viral hepatitis, HIV co-infection, advanced liver disease and a history of diseases influencing vitamin D status were excluded. Serum vitamin D measurement as well as liver function, viral load, HCV genotype, interleukin 28 and liver fibrosis assessments were performed.

          Results

          In all patients, the mean vitamin D serum concentration was 18.8 (± 8.9) ng/ml. The mean vitamin D level in HBV infected patients was lower than in HCV infected patients (17.6 ng/ml vs. 19.3 ng/ml; p = 0.43). Vitamin D status was assessed in relation to viral load, HCV genotype, interleukin 28 and sex, but the differences were not significant. In both groups, serum vitamin D levels were significantly lower in winter compared to summer (14.2 ng/ml vs. 23.9 ng/ml in patients infected with HCV [ p < 0.000001] and 14.7 ng/ml vs. 23.8 ng/ml in patients infected with HBV [ p < 0.001]).

          Conclusions

          Our study showed that in patients with chronic hepatitis C or chronic hepatitis B, insufficient 25(OH)D concentrations occur very often, but are not associated with poor virological characteristics. The only factor influencing the vitamin D level was the season.

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          Most cited references15

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          Prevalence of vitamin D deficiency in chronic liver disease.

          Vitamin D deficiency has been associated with cholestatic liver disease such as primary biliary cirrhosis. Some studies have suggested that cirrhosis can predispose patients to development of osteoporosis because of altered calcium and vitamin D homeostasis. The aim of this study was to determine the prevalence of vitamin D deficiency in patients with chronic liver disease. One hundred and eighteen consecutive patients (43 with hepatitis C cirrhosis, 57 with hepatitis C but no cirrhosis, 18 with nonhepatitis C-related cirrhosis) attending the University of Tennessee Hepatology Clinic had their 25-hydroxyvitamin D level measured. Severity of vitamin D deficiency was graded as mild (20-32 ng/ml), moderate (7-19 ng/ml) or severe ( 32 ng/ml. Of patients, 109/118 (92.4%) had some degree of vitamin D deficiency. In the hepatitis C cirrhosis group, 16.3% (7/43) had mild, 48.8% (21/43) had moderate, and 30.2% (13/43) had severe vitamin D deficiency. In the hepatitis C noncirrhotic group, 22.8% (19/57) had mild, 52.6% (30/57) had moderate, and 14% (8/57) had severe vitamin D deficiency. In the nonhepatitis C-related cirrhosis group, 38.9% (7/18) had mild, 27.8% (5/18) had moderate, and 27.8% (5/18) had severe vitamin D deficiency. Severe vitamin D deficiency (<7 ng/ml) was more common among patients with cirrhosis compared with noncirrhotics (29.5% versus 14.1%, P value=0.05). Female gender, African American race, and cirrhosis were independent predictors of severe vitamin D deficiency in chronic liver disease. Vitamin D deficiency is universal (92%) among patients with chronic liver disease, and at least one-third of them suffer from severe vitamin D deficiency. African American females are at highest risk of vitamin D deficiency.
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            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)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.
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              The High Prevalence of Vitamin D Insufficiency across Australian Populations Is Only Partly Explained by Season and Latitude

              Background Inadequate sun exposure and dietary vitamin D intake can result in vitamin D insufficiency. However, limited data are available on actual vitamin D status and predictors in healthy individuals in different regions and by season. Methods We compared vitamin D status [25-hydroxyvitamin D; 25(OH)D] in people < 60 years of age using data from cross-sectional studies of three regions across Australia: southeast Queensland (27°S; 167 females and 211 males), Geelong region (38°S; 561 females), and Tasmania (43°S; 432 females and 298 males). Results The prevalence of vitamin D insufficiency (≤ 50 nmol/L) in women in winter/spring was 40.5% in southeast Queensland, 37.4% in the Geelong region, and 67.3% in Tasmania. Season, simulated maximum daily duration of vitamin D synthesis, and vitamin D effective daily dose each explained around 14% of the variation in 25(OH)D. Although latitude explained only 3.9% of the variation, a decrease in average 25(OH)D of 1.0 (95% confidence interval, 0.7–1.3) nmol/L for every degree increase in latitude may be clinically relevant. In some months, we found a high insufficiency or even deficiency when sun exposure protection would be recommended on the basis of the simulated ultraviolet index. Conclusion Vitamin D insufficiency is common over a wide latitude range in Australia. Season appears to be more important than latitude, but both accounted for less than one-fifth of the variation in serum 25(OH)D levels, highlighting the importance of behavioral factors. Current sun exposure guidelines do not seem to fully prevent vitamin D insufficiency, and consideration should be given to their modification or to pursuing other means to achieve vitamin D adequacy.
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                Author and article information

                Journal
                Clin Exp Hepatol
                Clin Exp Hepatol
                CEH
                Clinical and Experimental Hepatology
                Termedia Publishing House
                2392-1099
                2449-8238
                30 April 2015
                May 2015
                : 1
                : 1
                : 5-11
                Affiliations
                Department of Infectious Diseases and Hepatology, Medical University of Lodz, Lodz, Poland
                Author notes
                Address for correspondence Aleksandra Berkan-Kawińska, Department of Infectious Diseases and Hepatology, Medical University of Lodz, 1/5 Kniaziewicza St., 91-347 Lodz, Poland. phone/fax: +48 42 251 62 65. e-mail: kchzak@ 123456csk.umed.lodz.pl
                Article
                25072
                10.5114/ceh.2015.51373
                5421164
                39cdef90-3c85-4ee6-91a1-92ab4f58b015
                Copyright: © 2015 Clinical and Experimental Hepatology

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International (CC BY-NC-SA 4.0) License, allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material, provided the original work is properly cited and states its license.

                History
                : 02 March 2015
                : 13 April 2015
                Categories
                Original Article

                vitamin d deficiency,hepatitis b,hepatitis c,antiviral treatment

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