{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T16:26:28Z","timestamp":1782491188528,"version":"3.54.5"},"reference-count":38,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2025,5,26]],"date-time":"2025-05-26T00:00:00Z","timestamp":1748217600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>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\u2014679 patients, HBV\u201498 patients, HBV\/HCV\u201425 patients, HBV\/HDV\u201414 patients, and 2 patients with triple-infection (HBV, HCV, and HDV), hospitalized in the Second Department of \u201cSf. Cuv. Parascheva\u201d Infectious Diseases Clinical Hospital of Gala\u021bi, Romania, between 1 April 2017 and 1 March 2025. Results: Comparative analysis of biochemical parameters and liver fibrosis\u2014at the initial testing\u2014i.e., at the beginning of the specific antiviral therapy\u2014with 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\u2014revealed 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.<\/jats:p>","DOI":"10.3390\/diseases13060168","type":"journal-article","created":{"date-parts":[[2025,5,27]],"date-time":"2025-05-27T03:34:46Z","timestamp":1748316886000},"page":"168","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["HBV, HCV, and HDV Triple-Infection\u2014A Therapeutic Challenge"],"prefix":"10.3390","volume":"13","author":[{"given":"Alexia Anastasia Stefania","family":"Balta","sequence":"first","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Apostol Andrei\u2019 Clinical Emergency County Hospital, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mariana Daniela","family":"Ignat","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"Clinical Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Cuv. Parascheva\u2019 Clinical Hospital of Infectious Diseases, 800179 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3466-4717","authenticated-orcid":false,"given":"Raisa Eloise","family":"Barbu","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"Clinical Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Ioan\u2019 Clinical Hospital for Children, 800487 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7602-8435","authenticated-orcid":false,"given":"Liliana","family":"Baroiu","sequence":"additional","affiliation":[{"name":"Clinical Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Cuv. Parascheva\u2019 Clinical Hospital of Infectious Diseases, 800179 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9688-0580","authenticated-orcid":false,"given":"Lavinia Alexandra","family":"Moroianu","sequence":"additional","affiliation":[{"name":"Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"Clinical Hospital of Psychiatry \u201cElisabeta Doamna\u201d, 800179 Gala\u021bi, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6620-7851","authenticated-orcid":false,"given":"Valerii","family":"Lutenco","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Apostol Andrei\u2019 Clinical Emergency County Hospital, 800578 Galati, Romania"},{"name":"Clinical Surgical Department, Faculty of Medicine and Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valentin","family":"Bulza","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"Galati Railways General Hospital, 800225 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-7881-2525","authenticated-orcid":false,"given":"Mihaela","family":"Patriciu","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Apostol Andrei\u2019 Clinical Emergency County Hospital, 800578 Galati, Romania"},{"name":"Clinical Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Dumitru","sequence":"additional","affiliation":[{"name":"\u2018Sf. Cuv. Parascheva\u2019 Clinical Hospital of Infectious Diseases, 800179 Galati, Romania"},{"name":"Department of Pharmaceutical Sciences, Faculty of Medicine and Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihaela","family":"Debita","sequence":"additional","affiliation":[{"name":"Medical Department, Faculty of Medicineand Pharmacy, \u2018Dunarea de Jos\u2019 University, 800008 Galati, Romania"},{"name":"\u2018Sf. Cuv. Parascheva\u2019 Clinical Hospital of Infectious Diseases, 800179 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"58","DOI":"10.24875\/AIDSRev.M17000012","article-title":"Report from the International Conference on Viral Hepatitis\u20142017","volume":"20","author":"Soriano","year":"2018","journal-title":"AIDS Rev."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1677","DOI":"10.1093\/infdis\/jiz633","article-title":"Estimating the Global Prevalence, Disease Progression, and Clinical Outcome of Hepatitis Delta Virus Infection","volume":"221","author":"Miao","year":"2020","journal-title":"J. Infect. 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