Today, a patient, 28 years old, chronic hepatitis B, severe fatty liver, with a family history of liver disease, liver function is not normal, in the external hospital taking adefovir treatment for 3 months, hepatitis B virus decline is not obvious, to consult the reasons and the next treatment plan: careful analysis of the reasons are as follows: 1, about the indications The patient has fatty liver, transaminase elevation does not necessarily indicate immune clearance, before treatment should be further verified The patient’s pre-treatment hepatitis B virus quantification is 8 times 10, the viral load is high, adefovir treatment is slow, so even if antiviral treatment should choose other potent antiviral drugs. The patient’s treatment suggests that it is important to choose suitable drugs and appropriate timing of antiviral, fatty liver is more common, and the real meaning of elevated transaminases must be confirmed before treatment.