HBV, HCV, and HDV Triple-Infection-A Therapeutic Challenge.

Purpose: This article aims to harmonize the current data from the literature, describe baseline severity, and discuss potential treatment considerations for cases of triple infection.

Patients and methods: We undertook a retrospective, observational study on 1244 patients with viral hepatitis study subgroups: chronic replicative hepatitis with HCV-679 patients, HBV-98 patients, HBV/HCV-25 patients, HBV/HDV-14 patients, and 2 patients with triple-infection (HBV, HCV, and HDV), hospitalized in the Second Department of "Sf. Cuv. Parascheva" Infectious Diseases Clinical Hospital of Galați, Romania, between 1 April 2017 and 1 March 2025.

Results: Comparative analysis of biochemical parameters and liver fibrosis-at the initial testing-i.e., at the beginning of the specific antiviral therapy-with direct-acting antivirals on HCV (DAAs) or nucleos(t)ide analogues (NUCs): Entecavir (ETV) or Tenofovir Disoproxyl fumarate (TDF), for HBV, Bulevirtide (BLV) for HDV-revealed clinical forms with higher severity in the case of triple and double infections, in comparison to individuals who have had only one hepatotropic virus infection.

Conclusions: Compared to patients with a single hepatotropic viral infection, those with a double or triple infection had more severe hepatic damage. Concomitant therapy with Bulevirtide, DAAs, and NUCs is possible and the therapeutic results from clinical studies, with single-infection patients showing great potential for improving the prognosis of these patients.