In a sensitivity analysis using HDV RNA instead of anti-HDV to define HDV coinfection, the difference in mean ALT values between participants with and without HDV coinfection increased to + 29 IU/L (95% CI 12–46) at baseline, + 31 IU/L (95% CI 18–44) after 2 years and + 40 (95% CI 18–62) after 5 years of tenofovir treatment in the multivariable model (Supplementary Figure 1). Here, GPT is linked to coinfection.