Viral Hepatitis Coinfection

Dear Colleagues,

Hepatitis B virus (HBV) is a major public health burden globally, particularly in low- and middle-income countries, due primarily to complications of cirrhosis and liver cancer. In many of these regions, the presence of other viral co-infections, including hepatitis C virus (HCV), hepatitis D virus (HDV), and human immunodeficiency virus (HIV), dramatically worsens the outcome and in some instances, complicates the management of chronic HBV infection. In this Special Issue of Viruses, we review the impact that viral co-infections have on chronic HBV infection and unique challenges that must be addressed to reduce the burden of disease. 

In the era of direct-acting antiviral therapies for HCV, access to care and treatment is the major challenge. Among HBV–HCV co-infected individuals, the decision to treat both viruses versus prioritized treatment for each needs to be addressed. The role of point-of-care testing and treatment will be reviewed, as well as monitoring for complications during and after curative therapy. 

Chronic HDV infection requires the helper function of HBV for its lifecycle and represents one of the most severe forms of viral hepatitis. Despite this dependence on HBV, the prevalence of HDV often does not mirror that of HBV. This paradox and the changing epidemiology of HDV will be reviewed. HDV is an undiagnosed disease due to a lack of awareness, low rates of screening of persons with chronic HBV infection, and limited treatment options. HDV screening tests and recommendations will be reviewed. The therapeutic pipeline for HDV is active, and an update of novel agents in development will be covered. 

The development of nucleos(t)ide analogue therapy for HIV has dramatically altered the outcome of HIV and has had downstream benefits to persons living with a HBV infection. HBV–HIV co-infected persons enjoy the benefits of being able to control both viruses with one pill. However, the outcome of liver disease among HBV–HIV co-infected persons in the era of anti-retroviral therapy remains incompletely understood and will be reviewed. The role of POC diagnostics in the diagnosis and linkage to care of persons with a HBV–HIV co-infection will be reviewed. 

We hope that this Special Issue, by identifying key knowledge gaps, will stimulate further research to improve the outcomes of millions of individuals with HBV co-infected with HCV, HDV, and HIV.

Dr. Daryl Lau
Guest Editor

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• viral hepatitis coinfection
• HBV co-infected with HCV, HDV, and HIV
• chronic viral hepatitis infection
• care and treatment