{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:58:08Z","timestamp":1790582288151,"version":"4.1.0"},"reference-count":15,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,20]],"date-time":"2026-09-20T00:00:00Z","timestamp":1789862400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Viral Hepatitis"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>HBV replication is commonly suppressed by HCV, and eradication of HCV with direct\u2010acting antivirals (DAAs) may favour HBV reactivation. Data on long\u2010term hepatic outcomes after HCV clearance in people living with HIV (PLWH) with triple viral infections are limited. We analysed all HIV\/HCV co\u2010infected participants in the ICONA and HepaICONA cohorts with complete HBV serology who achieved a sustained virological response (SVR) after DAA therapy. Participants were classified as HIV\/HCV, HIV\/HCV with isolated anti\u2010HBc positivity (IHBc), or HIV\/HCV\/HBV, with HDV testing when available. The outcomes included ALT normalisation, hepatitis flares, and two composite clinical endpoints: CO1 (HCC, hepatic decompensation, liver transplantation, or death) and CO2 (the same plus FIB\u20104 progression &gt;\u20093.25 in non\u2010cirrhotics). Among 1182 PLWH, 478 had HIV\/HCV, 651 had HIV\/HCV\u2009+\u2009IHBc, and 53 had HIV\/HCV\/HBV co\u2010infection; six were HDV RNA\u2010positive. The prevalence of triple co\u2010infection was 16.6% among HCV\u2010viraemic participants. Triple co\u2010infection reduced the likelihood of ALT normalisation (aHR 0.66, 95% CI: 0.45, 0.97); this effect was related to active HDV replication (aHR 0.39, 95% CI: 0.16, 0.94). Over 5213 person\u2010years, 26 hepatitis flares occurred (IR 0.50\/100 PYFU), with only one confirmed HBV reactivation (IR 0.25\/100 PYFU). Neither triple nor quadruple infection predicted severe liver events. In PLWH, HCV\/HBV co\u2010infection is relatively common but does not appear to increase hepatic morbidity after HCV cure under tenofovir\u2010based ART. Persistent ALT elevation after DAA therapy is mainly driven by replicating HDV, supporting routine HDV testing and timely antiviral management in this population.<\/jats:p>","DOI":"10.1111\/jvh.70230","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T06:30:35Z","timestamp":1789972235000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Persistent\n                    <scp>ALT<\/scp>\n                    Elevation and Liver Outcomes After\n                    <scp>DAA<\/scp>\n                    \u2010Induced\n                    <scp>HCV<\/scp>\n                    Cure in People With\n                    <scp>HIV<\/scp>\n                    : Impact of\n                    <scp>HBV<\/scp>\n                    and\n                    <scp>HDV<\/scp>\n                    Co\u2010Infections"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4965-8789","authenticated-orcid":false,"given":"Roberto","family":"Rossotti","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases ASST Grande Ospedale Metropolitano Niguarda  Milan Italy"},{"name":"Department of Diagnostics and Public Health University of Verona  Verona Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5899-451X","authenticated-orcid":false,"given":"Alessandro","family":"Tavelli","sequence":"additional","affiliation":[{"name":"ICONA Foundation  Milan Italy"},{"name":"National PhD Programme in One Health Approaches to Infectious Diseases and Life Science Research, Department of Public Health, Experimental and Forensic Medicine University of Pavia  Pavia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6561-5298","authenticated-orcid":false,"given":"Vincenzo","family":"Malagnino","sequence":"additional","affiliation":[{"name":"Department of Medicine of Systems University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2377-504X","authenticated-orcid":false,"given":"Valentina","family":"Svicher","sequence":"additional","affiliation":[{"name":"Department of Experimental Medicine University of Rome Tor Vergata  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1452-9100","authenticated-orcid":false,"given":"Eugenia","family":"Quiros\u2010Roldan","sequence":"additional","affiliation":[{"name":"Department of Infectious and Tropical Diseases University of Brescia and ASST Spedali Civili of Brescia  Brescia Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandra","family":"Bandera","sequence":"additional","affiliation":[{"name":"Infectious Disease Unit, Department of Internal Medicine Fondazione IRCCS Ca, Granda, Ospedale Maggiore Policlinico  Milan Italy"},{"name":"Department of Pathophysiology and Transplantation University of Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1293-5976","authenticated-orcid":false,"given":"Francesco Maria","family":"Fusco","sequence":"additional","affiliation":[{"name":"UOC Infezioni Sistemiche e dell'Immunodepresso, AORN Ospedali dei Colli, P.O. \u201cD. Cotugno\u201d  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0367-6941","authenticated-orcid":false,"given":"Marco","family":"Rivano Capparuccia","sequence":"additional","affiliation":[{"name":"Infectious and Tropical Disease Unit, Policlinico Umberto I, Department of Public Health and Infectious Diseases Sapienza University  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1573-6224","authenticated-orcid":false,"given":"Giovanni Battista","family":"Gaeta","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit University L. Vanvitelli  Naples Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0240-7504","authenticated-orcid":false,"given":"Valentina","family":"Mazzotta","sequence":"additional","affiliation":[{"name":"Clinical Infectious Diseases Department National Institute for Infectious Diseases Lazzaro Spallanzani IRCCS  Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3278-7138","authenticated-orcid":false,"given":"Massimo","family":"Puoti","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases ASST Grande Ospedale Metropolitano Niguarda  Milan Italy"},{"name":"School of Medicine and Surgery University of Milano\u2010Bicocca  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0073-1789","authenticated-orcid":false,"given":"Antonella","family":"d\u2019Arminio Monforte","sequence":"additional","affiliation":[{"name":"ICONA Foundation  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"ICONA\/HepaICONA Foundation Study Group","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,9,20]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1080\/14740338.2017.1325869"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.26400"},{"issue":"2","key":"e_1_2_12_4_1","first-page":"221","article-title":"The Spectrum of HBV\/HCV Coinfection: Epidemiology, Clinical Characteristics, Viralinteractions and Management","volume":"28","author":"Konstantinou D.","year":"2015","journal-title":"Annals of Gastroenterology"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29109"},{"key":"e_1_2_12_6_1","unstructured":"Food and Drug Administration \u201cFDA Drug Safety Communication: FDA Warns About the Risk of Hepatitis B Reactivating in Some Patients Treated With Direct\u2010Acting Antivirals for Hepatitis C \u201d (2016) https:\/\/www.fda.gov\/drugs\/drug\u2010safety\u2010and\u2010availability\/fda\u2010drug\u2010safety\u2010communication\u2010fda\u2010warns\u2010about\u2010risk\u2010hepatitis\u2010b\u2010reactivating\u2010some\u2010patients\u2010treated."},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep4.1794"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2025.03.018"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciw507"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciab971"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12879\u2010017\u20102287\u2010y"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.3389\/fcimb.2023.1143346"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijid.2024.107294"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1080\/20477724.2022.2047551"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/liv.15804"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2468\u20101253(25)00266\u20103"}],"container-title":["Journal of Viral Hepatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.70230","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/jvh.70230","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jvh.70230","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T07:42:41Z","timestamp":1790581361000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jvh.70230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,20]]},"references-count":15,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2026,10]]}},"alternative-id":["10.1111\/jvh.70230"],"URL":"https:\/\/doi.org\/10.1111\/jvh.70230","archive":["Portico"],"relation":{},"ISSN":["1352-0504","1365-2893"],"issn-type":[{"value":"1352-0504","type":"print"},{"value":"1365-2893","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,20]]},"assertion":[{"value":"2026-01-11","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-08","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-20","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70230"}}