Ok, we understand the situation. What is your question?

So he got hepatitis B, E and delta in one person?

If the patient has antibodies against HEV and HDV, it is reasonable to assume that he has been infected with these virus. If he had also been infected with HBV, one would expect antibodies against this virus. Raised IgG indicates an ongoing infection, but not with what. AFAIK, it is usual to determine circulating virus antigen and nucleic acid to ascertain how active the infection is. In addition, liver enzymes can be determined in serum, to measure liver damage. Whether a liver biopsy is indicated, only an experienced internist can tell.

Could be an example for Hickam's dictum: "Patients can have as many diseases as they darn well please".

HDV replication is dependent on HBV enzymes. so if one has HDV, he should have HBV.

could this case be considered as autoimmune hepatitis followed by infection with hepato-tropic viruses and need cortico-steroid therapy

Acually hep B Pcr level is undetectable and ANA. ASMA are at the level of positive more than 1 / 80

Amended on 27 April 2019

I must sadly and repeatedly say that RIA, ELISA, PCR, Western blot, Electron microscope, HPLC-MS, MS and Flow cytometry are not reliable and not quantitative methods at all. Therefore, recently developed PDMD (Protein-Direct-Microsequencing-Deciphering) method should be used instead (please see files; HepG2 Fucoidin and JMBT Alopecia).

By the way, we have detected HBV in three human liver biopsies out of five liver biopsies as assessed by the PDMD method (our unpublished observation).

Normal human liver (with pseudo-liver cancer; male) has DNA polymerase (HBV) at 5.1 μg/mg of tissue protein. HDV is not detected.

HCC tissue (with PBC; female) has DNA polymerase (HBV) at 2.2 μg/mg of tissue protein. This tissue also has Delta antigen (Hepatitis delta virus/HDV) at 2.7 μg/mg of tissue protein and Non-structural polyprotein (HEV) at 7.5 μg/mg of tissue protein. This tissue simultaneously has HBV, HDV, and HEV.

HCC tissue (named as No.6, male) has Major surface antigen/Large envelope protein (HBV) at 0.17 μg/mg of tissue protein. HDV is not detected.

Interstingly, LC tissue (No.6) has no HBV and HDV.

Further, ASMA/NEM2/Alpha-actin-1/MPFD/Actin, alpha skeletal muscle/Actin, alpha 1, skeletal muscle/NEM1/CFTDM/ACTA/CFTD/CFTD1/NEM3/ACTA1 and Protein anachronism/ANA/Protein BTG3/Abundant in neuroepithelium area protein/BTG family member 3/Protein Tob5/BTG3/TOB5 are not present in Humans as assessed by the reliable PDMD method. This may be due to Species differences and utilization of notorious Electron Microscopy. Therefore, the utilization of Immunological methods is very dangerous giving false positive and false negative results.

Further, I have recently sadly found that Actin, Myoglobin, and Tubulin are not present in Humans. This may also be due to Species differences and utilization of notorious Electron Microscopy.

Myosin may be remained in human smooth muscle.

Human striated muscle seems to be contracting by utilizing Connectin/Titin, Albumin, and Haemoglobin. NADH seems to be the energy source, and notorious ATP cannot contract Human muscle (manuscript in preparation). Active transport is occurring by using NADH as an energy source (please seee file; Ala Transport).

Only human breast milk has Actin-like protein 7A at 2.2 μg/mg of milk protein

Thus, Fucoidan/Fucoidin (derived from Japanese edible Brown alga of Mozuku) seems to be effective also onto HBV (please see also the files; HepG2 Fucoidin and Rat DEN Np-Fuco). Fucoidan can inhibit reverse transcriptase (RT) safely. But, the DNA analog of Entecavir is not so effective due to the aquired resistant ability of HBV's RT. Further, I have recently found that normal humans has RT; i.e., LC tissue (named as No.6; male) has Line-1 reverse transcriptase homolog/LINE-1 retrotransposable element ORF2 protein at 1.3 μg/mg of tissue protein, but HCC tissue of this person has not it. Reverse transcriptase (RT) of Humans may be normally working. Then, Entecavir may cause serious side effect to Humans.

Fibroscan for this patient was progressed from f2 to f3 inspite of entecavir therapy