The general indications for antiviral therapy for chronic hepatitis B are not set in stone. Sometimes the indications can be relaxed without having to wait until the alanine aminotransferase (ALT) rises to twice the upper limit of normal; and sometimes antiviral therapy can be given without haste. So when can the indications for antiviral therapy be relaxed or withheld? Indications for treatment should be relaxed in older individuals, in patients with cirrhosis, and in patients undergoing immunosuppressive drugs or chemotherapy. many infected individuals over the age of 40 have entered the reactivation phase in the natural history of hepatitis B virus infection. During this period, sometimes the ALT elevation is not obvious, often less than twice the upper limit of normal value; HBV DNA is also often less than 104 copies/mL, and even undetectable in patients with cirrhosis.However, it does not mean that the virus has less destructive activities in the liver, but the virus hides deeper, the destructive activities are more hidden and more likely to lead to cirrhosis or hepatocellular carcinoma. Therefore, the 2010 edition of “Chronic Hepatitis B Prevention and Control Guidelines” specifically put forward the opinion that antiviral indications for hepatitis B virus infected patients over 40 years of age should be appropriately relaxed, and it is believed that these infected patients should be treated with antiviral therapy as long as the ALT is abnormal or the pathological changes in the liver biopsy are obvious; and cirrhotic patients with abnormalities of one of the three elements, namely, ALT, oxaloacetic acid transferase (AST), or HBV DNA, should be treated with antiviral therapy. Antiviral therapy is indicated for patients with cirrhosis. Patients on immunosuppressive drugs or chemotherapy often suffer more severe viral damage and liver damage due to immune suppression and liver damage caused by chemotherapeutic drugs. Therefore, the Guidelines for the Prevention and Control of Chronic Hepatitis B suggest that these patients should be treated with antiviral therapy as long as they are screened positive for hepatitis B surface antigen, regardless of whether their ALT is elevated or not, and whether the virus is replicating or not. In addition, the Guidelines for the Prevention and Control of Chronic Hepatitis B also suggests that if dynamic observation reveals evidence of disease progression (e.g., splenomegaly), it is recommended that liver histologic examination be performed, and antiviral therapy be given if necessary. Treatment of hepatitis B virus-infected patients who meet the indications for antiviral therapy can sometimes be withheld, but withholding treatment is not mentioned in either edition of the Guidelines for the Prevention and Control of Chronic Hepatitis B. According to the author’s clinical experience, hepatitis B virus carriers with a sudden rise in ALT to more than 10 times the upper limit of normal value, acute attack of hepatitis B, a few of these patients are the body to occur spontaneous immune clearance, there may be spontaneous serological conversion of e antigen or even surface antigen, so there may be no urgency to implement antiviral therapy, only use hepatoprotective and anti-inflammatory medications, and dynamic observation of about 1 month, if the patient’s ALT If the patient’s ALT and HBV DNA decrease rapidly and the e antigen disappears, spontaneous immune clearance may occur; if the virus continues to replicate and the decrease of ALT is not satisfactory, then antiviral therapy can be considered. However, sometimes after spontaneous immune clearance, relapse may occur even after a smooth period of time. So patients should still be monitored. In addition, interferon therapy is not suitable for patients whose ALT suddenly rises to more than 10 times the upper limit of normal value. Temporarily administering hepatoprotective and anti-inflammatory drugs and waiting for the ALT to decrease appropriately before using interferon therapy is also a strategy of antiviral therapy for many doctors.