Triple Burden of HIV, HBV and HDV in Adults with Childhood Parenterally Acquired Infections: A Romanian Single-Center Study

Background: Co-infections with HIV, HBV, and HDV pose significant public health challenges, especially in populations exposed parenterally. Romania hosts a unique pediatric HIV cohort of individuals born 1987–1995 who acquired HIV iatrogenically. This study assessed the prevalence, hepatic impact, and management of HIV–HBV–HDV co-infection in 130 long-term survivors from Galați County. Methods: Patients underwent clinical, laboratory, and FibroScan assessments. HBV and HDV serology and viral loads were measured, and antiretroviral therapy regimens, including tenofovir-based therapies, were reviewed. Entecavir or Bulevirtide was applied when indicated. Results: HBV infection was present in 57.7% of cohort patients versus 20% in non-cohort PLWH, and HDV co-infection in 7.7% of cohort patients. Hepatic fibrosis increased from HBV-uninfected to HBV/HDV co-infected individuals. HIV impairs viral clearance and exacerbates liver injury via immune dysregulation and chronic inflammation. Despite TDF-based ART, replicative HBV was detected in eight patients, managed with Entecavir. Bulevirtide therapy for HDV was initiated in eligible patients, with minor adverse events. Conclusions: Pediatric HIV cohort survivors show high rates of HBV and HDV co-infection and progressive hepatic fibrosis. Optimized antiviral therapy and adherence support are essential to control viral replication and reduce liver-related complications.