Clinical Course and Symptoms


Infection with HDV is double trouble since it always infects someone who already has HBV infection as well. HDV causes similar symptoms as HBV does but the severity can be much worse (see table below). In fact the mortality rate of HDV can be up to ten times higher the rate of HBV-infection alone. There are two types of HDV infection which have different courses.


HDV-HBV coinfection is where someone gets HDV and HBV at the same time. This is the less serious form and only results in chronic liver disease in 1-3% of cases. However, the HDV presence does make the risk greater than if there was just HBV alone.





HDV-HBV superinfection is the more common and more serious form of HDV. This is where someone who already has chronic Hepatitis B suddenly gets a worse infection because of exposure to HDV. This is also called fulminant hepatitis. It turns out that most cases where viral hepatitis suddenly becomes very sever are due to HDV. This condition can lead to chronic Hepatitis D disease which is often fatal.



HBV-HDV coinfection

More Common / More Serious

Large numbers of hepatocytes are already producing HBsAg 
HDV replicates faster (incubation 3 weeks) 
Fatality rates from fulminant hepatitis up to 20%




Preicteric phase: fatigue, lethargy, anorexia, nausea, headache for 3-7 days
Icteric phase: jaundice, fatigue and nausea - clay-colored stools and dark urine.
often asymptomatic

Incubation period of 3 to 7 weeks
manifested in single episode (simultaneous HBV/HDV replication) or in two episodes (sequential HBV/HDV replication)
Disease is over in 6 months

HBV-HDV coinfection could lead to more severe cases than HBV-only infection

Higher incidence of fulminant hepatitis

Low incidence of chronic hepatitis (1-3%)


jaundice, coagulopathy
hepatic encephalopathy
-changes in personality, disturbances in sleep, confusion, difficulty concentrating, occasionally abnormal behavior

severe, rare form of viral hepatitis
results in acute, massive destruction of large portions of the liver

Mortality: 80%
indication for orthotopic liver transplantation

ten times more likely than HBV-only cases


Almost all superinfection cases proceed to chronic hepatitis

similar to acute hepatitis but less severe
ongoing liver inflammation

70-80% develop cirrhosis compared to 15-30% with only chronic HBV infection

Cirrhosis leads to liver failure and portal hypertension

Death results from bleeding, hepatic coma, infection, or kidney failure

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