The treatment of chronic hepatitis B mainly includes antiviral, immunomodulatory, anti-inflammatory and hepatoprotective, anti-fibrotic and symptomatic therapy, among which antiviral therapy is the key, and standardized antiviral therapy should be performed as long as there is an indication and conditions allow. For chronic hepatitis B, a combination of antiviral-based treatment is necessary to maximize the inhibition of viral replication, reduce hepatocyte inflammation and necrosis and liver fibrosis, and thus improve the quality of life. When and under what circumstances antiviral therapy should be started for a specific patient is an issue that requires not only the attention of the physician but also the full understanding and cooperation of the patient. When in the immune tolerance phase of hepatitis B, i.e., the pathogenic carrier state, on the one hand, the hepatitis B virus does not directly damage the liver, and on the other hand, the body’s immune system does not attack the virus. This relatively stable state is characterized by normal liver function, and drug therapy will not have any effect at this time. Once the body’s immune system starts to recognize and remove the virus from the liver cells, the result of the struggle between the two is a hepatitis attack, which is manifested by abnormal liver function, such as an increase in transaminases. Therefore, although elevated transaminases are not a good thing, they reflect the body’s increased immune function against the hepatitis B virus. In this case, antiviral therapy should be started. Generally, antiviral therapy is most effective when the patient’s transaminases are elevated to more than 2 to 3 times the upper limit of normal values, while the efficacy of antiviral therapy is poor with low abnormal transaminases. Do not interpret antiviral therapy as “down” virus therapy. Some patients are so anxious to see the presence of millions of viruses in their serum that they blindly use antiviral therapy, regardless of whether they are eligible or not. This is because the amount of viral content does not parallel liver lesions. On the contrary, the viral load is highest when there is no liver lesion; whereas, the viral load decreases when the transaminase is elevated. Therefore, the decision of whether antiviral therapy should be administered must also be made by the doctor. Currently, there are two major categories of internationally recognized anti-hepatitis B virus drugs, interferon and nucleoside analogues, of which interferon is not ideal for treatment, with only about 30% efficiency and a large number of adverse effects. Nucleoside analogue antiviral drugs have a long course of treatment, and long-term treatment leads to virus mutation and drug resistance problems. Therefore, the maximum potential of antiviral therapy can only be achieved under the guidance of an experienced physician, by choosing the right time for treatment, proper use of medication, close observation, and regular review and follow-up.