The indication for antiviral therapy is determined by serum HBV DNA levels, serum ALT and severity of liver disease, as well as by a comprehensive assessment of the patient’s risk of disease progression in conjunction with factors such as age, family history and concomitant disease, before deciding whether to initiate antiviral therapy. A dynamic assessment is more clinically relevant than a single test. In HBeAg-positive patients, after ALT levels are found to be elevated, observation for 3-6 months may be considered, and if spontaneous HBeAg serological conversion does not occur and ALT continues to be elevated, antiviral therapy may be considered again. (1) HBV DNA level: HBV DNA ≥20 000 IU/mL (equivalent to 10 5 copies/mL) for HBeAg-positive patients; HBV DNA ≥2000 IU/mL (equivalent to 10 4 copies/mL) for HBeAg-negative patients; (2) ALT level: generally required (2) ALT level: the general requirement is a persistent elevation of ALT ≥ 2 × ULN; if treated with interferon, ALT should generally be ≤ 10 × ULN and total serum bilirubin should be < 2 × ULN; for persistent HBV DNA positivity, those who do not meet the above treatment criteria, but have one of the following circumstances, the risk of disease progression is higher, antiviral therapy can be considered: (1) the presence of significant liver inflammation (grade 2 or higher) or fibrosis, especially (1) Significant liver inflammation (grade 2 or higher) or fibrosis, especially liver fibrosis grade 2 or higher (A1). (2) Persistent ALT between 1 × ULN and 2 × ULN, especially in those >30 years of age, liver tissue biopsy or noninvasive examination is recommended, and antiviral therapy is indicated if liver inflammation or fibrosis is evident (B2). (3) Persistently normal ALT (checked every 3 months), age >30 years, with a family history of cirrhosis or HCC, a liver tissue biopsy or noninvasive examination is recommended, and antiviral therapy is given if liver inflammation or fibrosis is evident (B2). (4) In the presence of objective evidence of cirrhosis, aggressive antiviral therapy is recommended regardless of ALT and HBeAg status (A1). It is important to exclude ALT elevation due to co-infection with other pathogens, drugs, alcohol and immunity before starting treatment, and to note the temporary normalization of ALT after application of enzyme-lowering drugs.