Brief Article
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World J Hepatol. Jun 27, 2013; 5(6): 328-331
Published online Jun 27, 2013. doi: 10.4254/wjh.v5.i6.328
Normal vitamin D levels are associated with spontaneous hepatitis B surface antigen seroclearance
Mahmud Mahamid, William Nseir, Omar Abu Elhija, Shimon Shteingart, Ammad Mahamid, Mosab Smamra, Benjamin Koslowsky
Mahmud Mahamid, Shimon Shteingart, Mosab Smamra, Benjamin Koslowsky, Digestive Disease Institute, Shaare Zedek Medical Center, Jerusalem 93722, Israel
Mahmud Mahamid, Mosab Smamra, Benjamin Koslowsky, Liver Unit, Shaare Zedek Medical Center, Jerusalem 93722, Israel
Mahmud Mahamid, William Nseir, Omar Abu Elhija, Ammad Mahamid, Liver Unit, Holy Family Hospital, Nazareth 16100, Israel
William Nseir, Omar Abu Elhija, Infectious Disease Unit, Holy Family Hospital, Nazareth 16100, Israel
Author contributions: Mahamid M and Abu Elhija O developed the concept and design of the study; Nseir W, Mahamid A and Smamra M acquired the data collected from the two main sources; Shteingart S contributed to the statistical analysis of the data; Koslowsky B performed major article revisions, including the final approval of the manuscript.
Correspondence to: Mahamid Mahmud, MD, Digestive Disease Institute, Shaare Zedek Medical Center, 12 Shmuel Biet, Jerusalem 93722, Israel. mahmudmahamid@yahoo.com
Telephone: +972-2-6666116 Fax: +972-2-6540744
Received: February 19, 2013
Revised: May 16, 2013
Accepted: May 18, 2013
Published online: June 27, 2013
Abstract

AIM: To investigate a possible association between serum vitamin D levels and spontaneous hepatitis B surface antigen (HBsAg) seroclearance.

METHODS: Fifty-three patients diagnosed with chronic inactive hepatitis B and spontaneous HBsAg seroclearance were followed up in two Israeli liver units between 2007 and 2012. This retrospective study reviewed medical charts of all the patients, extracting demographic, serological and vitamin D rates in the serum, as well as medical conditions and current medical therapy. Spontaneous HBsAg seroclearance was defined as the loss of serum HBsAg indefinitely. Vitamin D levels were compared to all patients who underwent spontaneous HBsAg seroclearance.

RESULTS: Out of the 53 patients who underwent hepatitis B antigen seroclearance, 44 patients (83%) had normal levels of 25-hydroxyvitamin vitamin D compared to 9 patients (17%) who had below normal levels. Multivariate analysis showed that age (> 35 years) OR = 1.7 (95%CI: 1.25-2.8, P = 0.05), serum vitamin D levels (> 20 ng/mL) OR = 2.6 (95%CI: 2.4-3.2, P = 0.02), hepatitis B e antigen negativity OR = 2.1 (95%CI: 2.2-3.1, P = 0.02), low viral load (hepatitis B virus DNA < 100 IU/mL) OR = 3 (95%CI: 2.6-4.2, P = 0.01) and duration of HBsAg seropositivity (> 8 years) OR = 1.6 (95%CI: 1.15-2.6, P = 0.04) were also associated with spontaneous HBsAg seroclearance.

CONCLUSION: We found a strong correlation between normal vitamin D levels and spontaneous HBsAg seroclearance.

Keywords: Hepatitis B, Vitamin D, Immune disease, Seroclearance, Viral load

Core tip: Vitamin D has recently been linked to many autoimmune diseases. Hepatitis B is a viral disease but shows many autoimmune characteristics. Spontaneous hepatitis B seroclearance is an unexplained phenomenon. The hypothesis of this paper was that normal vitamin D levels may be linked to a positive effect on hepatitis B. We showed that normal vitamin D levels correlate positively with spontaneous hepatitis B seroclearance. This finding may help to expand the therapeutic options for this disease.