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.