The incubation period of Hepatitis D depends on the method of infection. Hepatitis D infection cannot occur without Hepatitis B infection, but it is possible to acquire both at the same time, or first chronic HBV and subsequently contract HDV. The first case is called coinfection and the second is known as superinfection.



Coinfection cases are usually acute self-limiting episodes. Incubation time can depend on the HBV titers at the time of infection, but usually acute Hepatitis D illness is seen after 3-7 weeks. One to two recurrent episodes may be experienced, but chronic Hepatitis is unusual and seen in only 5% of cases.



Superinfection cases are usually much more severe than either coinfection or regular Hepatitis B infection. After HDV infection, a severe acute phase follows a short incubation period and leads to chronic HDV infection in 80% of cases. Superinfection can also lead to fulminant hepatitis, with sudden and severe symptoms, or chronic active hepatitis leading to cirrhosis of the liver in 60-70% of cases. Cirrhosis can take 5-10 years to develop, although it can appear in as few as 2. Chronic sufferers can also develop hepatocellular carcinoma (HCC), cancer of the liver, due to the damage inflicted by cirrhosis.


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