Hepatitis B infection remains a significant global health concern, with hepatitis D co-infection observed in approximately 5% of the patients. Treatment options for hepatitis D are currently limited, with most therapies awaiting approval by the FDA. However, there is a lack of comprehensive data on the prevalence and clinical presentation of patients with hepatitis B and D coinfection, particularly in Pakistan. In this study, we aimed to compare demographic characteristics, clinical presentations, laboratory, and endoscopic parameters along with the different treatment options between patients with hepatitis B monoinfection and those with hepatitis B and D coinfection.