Vitamin D levels in patients with chronic hepatitis B

We read with interest the article by Farnik et al.1 regarding the low vitamin D levels in patients with chronic hepatitis B virus (HBV). A remarkable finding was the inverse relationship between serum vitamin D levels and HBV viral load.

A previous study in patients with chronic hepatitis C had also shown that necroinflammatory activity as well fibrosis scores were independently linked to low vitamin D levels.2 Because of small cohort size, the researchers could not show an association between serum vitamin D levels and fibrosis scores. However, considering that necroinflammatory activity was not included in statistical analysis in this study; we would like to point out that high necroinflammatory activity may also explain the low vitamin D levels in patients with HBV. Before drawing a definitive conclusion, more details ought to be presented about this important issue.