China has made great achievements in the control of hepatitis B. The universal vaccination of newborns against hepatitis B has reduced the HBsAg-positive rate from a high prevalence to a medium-high prevalence, and the number of new patients has been very small. However, from the current treatment of hepatitis B, there are still three major challenges: ① the total number of HBsAg-positive patients is still very high, the HBsAg-positive rate is about 5% to 6%, according to this estimate, there are 70 million people in the country who are HBsAg-positive, and among them there are about 20-30 million patients who need treatment, and improving the treatment rate of this population is the biggest challenge; ② the clinical use of medication and the guideline recommendations are not consistent, due to the price of medicines and the cost of medicines in China. ② Clinical drug use is not consistent with the guideline recommendations, due to the price of drugs and medical insurance reimbursement policy in China needs to be improved, the clinical choice of drugs compared with the international guideline recommendations there is a discrepancy. (iii) The standardization of the training of doctors in China needs to be further improved, and there are problems such as non-standardized treatment plans and arbitrariness, which are not conducive to the long-term efficacy of patients. Hepatitis B treatment goal: most of the “maximum inhibition of HBV”, a few “clinical cure” At present, there is no uniform international standard for “clinical cure” of hepatitis B. The relatively more recognized standard is HBV. At present, there is no uniform international standard for the “clinical cure” of hepatitis B. The relatively accepted standard is that HBsAg is negative, liver function is normal, and liver tissue and blood are basically normal. The real complete cure should be the complete disappearance of covalent closed-circle DNA (cccDNA) in liver tissue, which is difficult to achieve. In general, HBsAg conversion (or better yet, HBsAb) is considered a “clinical cure”. To date, the goal of treatment for the vast majority of patients with chronic hepatitis B has been to achieve either maximum HBV DNA suppression or HBeAg seroconversion (i.e., the presence of HBeAb). This enables a more stable state to be maintained with or without long-term medication, keeping the disease under control and delaying progression. When the patient’s HBV DNA has been suppressed, HBeAg has become negative and HBeAb antibodies have appeared, and the HBsAg level is low (1,000 to 1,500 IU/mL), then it is possible to achieve the so-called “clinical cure” through further treatment, but this type of patient accounts for a very small proportion of the total treatment population. However, the proportion of such patients in the overall treatment population is very small. Therefore, for the majority of patients, the goal of treatment is to control HBV, slow disease progression, and improve quality of life. In other words, treatment is the “icing on the cake” for the majority of patients and the “icing on the cake” for only a minority of patients. Hepatitis B Treatment Endpoints: Lack of Effective Tipping Points, Long-Term Treatment is the Basic Strategy Hepatitis B treatment endpoints are an enduring topic. On the one hand, most patients require long-term treatment. For patients with cirrhosis, current guidelines at home and abroad agree that long-term treatment should be given and should not be discontinued. This is because once the drug is discontinued, disease relapse or exacerbation can occur, which can have serious clinical consequences. For HBeAg-negative patients with chronic hepatitis B, existing experience and studies have confirmed that the relapse rate after stopping the drug is also very high. Therefore, these two types of patients basically do not advocate the discontinuation of the drug, and should be long-term or even lifelong use of the drug. On the other hand, for HBeAg-positive patients, after treatment with nucleoside (acid) analogs, long-term HBV DNA conversion, HBeAg seroconversion, and even different degrees of HBsAg decline, these patients have been observed and studied, and it is found that at least a considerable number of patients can continue to stabilize after stopping the drug. Therefore, we hope to be able to find this group of people so that they can stop taking the drug. The difficulty, however, is that no very good tipping point has yet been identified. It is known that the longer the duration of treatment, the better, but there is still no clear time limit; it is known that patients with low age are not prone to relapse after stopping the drug, while the older the more likely to relapse, but the age threshold is not easy to determine; it is known that it is relatively safe to stop the drug when the HBsAg level drops to a certain degree after treatment, but the specific threshold is not well determined, these are all issues that need to be thoroughly researched in the future. The concepts and goals of the WHO guidelines and our guidelines are consistent The WHO guidelines for the prevention and treatment of chronic hepatitis B take into account many resource-constrained factors and are mainly aimed at developing countries, such as those in Africa and Southeast Asia. China’s economic development level is between the least developed and the most developed countries, so the consideration and attitude towards the WHO guideline should be between the two. For example, the guideline strongly recommends tenofovir and entecavir as the first choice of treatment and clearly opposes the use of other drugs in treatment, which is a very advanced concept for China, so our guideline basically follows this principle; on the other hand, because of resource constraints, the WHO guideline gives the minimum recommendation for monitoring and examination in treatment, such as at least 1 yearly review, which may be very important for patients in China. On the other hand, because of resource constraints, the WHO guidelines give minimum recommendations for monitoring and checking during treatment, such as at least 1 review per year, which may be too low for our patients, so the recommendations for review in our guidelines have already exceeded the minimum requirements of the WHO. Overall, the concepts and goals of the WHO guidelines and our guidelines are the same, and depending on the resources, some of the contents should be actively closer to the WHO guidelines, while some of them may have already exceeded the minimum standards of the WHO guidelines, and there are better and more desirable recommended measures. Therefore, we should not look at the WHO guideline and our guideline in a one-sided or even antagonistic way; the spirit and concept of the two guidelines are actually the same.