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Hepatitis B virus (HBV) and hepatitis C virus (HCV) pose significant public health challenges globally, being primary contributors to chronic hepatitis, cirrhosis, and hepatocellular carcinoma (HCC). Co-infections of HBV with HCV or HDV can present distinct sonographic and serologic findings that are valuable for diagnosis. This study compares sonographic and serologic findings in patients with HBV/HCV and HBV/HDV infections. The study involved 300 chronic hepatitis B patients, aged 13, in Birjand, Iran, who underwent blood tests and liver sonography. Statistical methods like Chi-square, Fisher's exact test, ANOVA, and Kruskal-Wallis tests were used for analysis. A study involving 300 patients found that those with HBV/HDV co-infection exhibited significantly higher average levels of AST, ALT, total bilirubin, direct bilirubin, and prothrombin time compared to patients with HBV/HCV co-infection. This indicates more severe liver impairment in the HBV/HDV group (P = 0.01). The study found no significant difference in alpha-fetoprotein levels between HBV/HDV and HBV/HCV patients, and no significant differences in liver conditions, fibrosis, ascites, or cirrhosis among the two groups. Overall, liver enzyme levels and prothrombin time were significantly elevated in patients with dual HBV and HDV infections compared to those with dual HBV and HCV infections. Furthermore, the former group exhibited significant sonographic findings indicative of disease progression and a poorer prognosis

Keywords: Hepatitis B, Hepatitis D, Hepatitis C, Liver Enzymes, Serologic changes, Sonographic findings.

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