Hepatitis B virus (HBV) infection is a global public health issue and is a major cause of cirrhosis and hepatocellular carcinoma (HCC). Hepatitis D virus (HDV) requires the hepatitis B surface antigen (HBsAg) to replicate. The eradication of HBV, therefore, can also cure HDV. The current therapies for chronic hepatitis B and D are suboptimal and cannot definitely cure the viruses. In order to achieve functional or complete cure of these infections, novel therapeutic agents that target the various sites of the viral replicative cycle are necessary. Furthermore, novel immunomodulatory agents are also essential to achieve viral clearance. Many of these new promising compounds such as entry inhibitors, covalently closed circular DNA (cccDNA) inhibitors, small interfering RNAs (siRNAs), capsid assembly modulators and nucleic acid polymers are in various stages of clinical developments. In this review article, we provided a comprehensive overview of the structure and lifecycle of HBV, the limitations of the current therapies and a summary of the novel therapeutic agents for both HDV and HBV infection.

Hepatitis B virus (HBV) remains a global public health problem despite the availability of effective vaccine and antiviral therapy. Cytomegalovirus (CMV), another hepatotropic virus, is also very prevalent in the general population worldwide. Both HBV and CMV can persist in the host and have potential to reactivate especially with weakened host cellular immunity. Superimposed CMV infection can lead to severe HBV reactivation. The pathogenesis of the co-infection of HBV and CMV remains poorly understood. Studies reported conflicting results regarding the inhibitory effect of CMV on HBV replication. There is an unmet need on the management of co-infection of HBV and CMV; research initiatives dedicated to understanding their interactions are urgently needed.

Left atrial masses can present diagnostic challenges due to the wide range of etiologies they can encompass. We present a unique case of a 48-year-old patient with ischemic cardiomyopathy and end-stage renal disease (ESRD) on hemodialysis, who developed a left atrial mass after undergoing intervention with drug-eluting stents. The differential diagnosis included left atrial thrombus versus fungal mass. The patient presented with chest pain and subsequently developed sepsis during the hospital stay, with further workup revealing evidence of fungemia. Transthoracic echocardiography (TTE) demonstrated the presence of a new mass in the left atria. The challenge was to differentiate between a left atrial thrombus and a fungal mass. The patient was managed with a combination of antifungal therapy and anticoagulation and was discharged home. This case highlights the diagnostic complexities and management considerations associated with left atrial masses in patients with underlying ischemic cardiomyopathy, ESRD, and septic complication versus cardiogenic shock. Accurate differentiation between left atrial thrombus and fungal mass is crucial to guide appropriate treatment strategies. A multidisciplinary approach involving cardiology, infectious diseases, and nephrology is essential in managing such complex cases.

We present a case of a woman in her 50s with chronic hepatitis B (CHB) who had a longstanding history of arthralgia and swollen joints associated with severe fatigue. Investigations were consistent with a diagnosis of hepatitis B virus (HBV)-related cryoglobulinaemia. Two months after treatment with tenofovir alafenamide, an antiviral therapy for HBV, there was a significant improvement of her symptoms and undetectable serum cryoglobulins. Cryoglobulinaemia is a relatively rare extrahepatic manifestation of HBV infection and only presents in about 2%–4% of the patients with CHB. Its clinical manifestations include purpura, renal dysfunction, arthralgias and neuropathy. Since the presentation of cryoglobulinaemia in CHB can be non-specific, one needs to have a high index of suspicion to avoid delay in diagnosis and treatment.