Currently, there are two major classes of drugs used for the antiviral treatment of patients with chronic hepatitis B: interferons and nucleoside analogues. How can we make the right choice? First, we introduce the drugs from different perspectives, and then, summarize, hoping to give you some guidance. The first, interferon class: including ordinary interferon and pegylated interferon: mechanism of action: through the induction of antiviral protein and regulation of the body’s immune function and other ways to play antiviral effect. 1, ordinary interferon: mainly alpha-interferon, a 48-week study for HbeAg-positive slow hepatitis B patients showed that the HBV-DNA negative rate is 37%, HbeAg seroconversion rate is 18%, HbsAg seroconversion rate is 7.8%; and for HbeAg-negative slow hepatitis B patients, 1-year HBV-DNA negative rate is 38-59%, but the efficacy is not long-lasting. European studies showed that 5-10% of HbsAg disappeared after 1 year of treatment and 11-25% after 5 years of treatment, but the same results were not seen in Asian studies and need to be further examined. 2, pegylated alpha-interferon: including alpha-2a, alpha-2b interferon, the two relative molecular weight differences, the former is 4.0 * 104, the latter is 1.2 * 104, are better than ordinary interferon, does not produce drug resistance, mild adverse reactions, but more expensive. A 24-week randomized controlled study showed that the HbeAg seroconversion rate was 32% in the pegylated alpha-interferon group, 27% in the combined group of pegylated alpha-interferon and lamivudine, and 19% in the lamivudine alone group. Nucleoside analogues: 1. Lamivudine (LVD): By inhibiting the reverse transcriptase and viral polymerase of HBV, it effectively prevents the synthesis of viral nucleic acid. A 48-week study of HbeAg-positive patients with chronic hepatitis B showed that 98% of the patients had varying degrees of HBV-DNA reduction and 50% of the patients had improved liver histology. Therefore, lamivudine has better efficacy, fewer adverse effects, and is better tolerated by patients, but the proportion of patients with viral resistance mutations increases with prolonged dosing time (5-year resistance rate up to 70%), limiting its long-term use. 2, Adefovir (ADV): Adenine phosphate compound, has antiviral activity against both wild-type HBV and LVD-resistant HBV, and no cross-resistance with LVD. A 1-year study in HbeAg-positive patients with chronic hepatitis B showed a 21% HBV-DNA negative rate, a 12% HbeAg seroconversion rate, and a 48% ALT reversion rate, and a 3-year study showed a 56% HBV-DNA negative rate and a 43% HbeAg seroconversion rate. A study of HbeAg-negative patients with chronic hepatitis B at 1, 2, and 5 years showed that the 1-year HBV-DNA negative rate was 51% and the ALT normalization rate was 72%; the 2-year HBV-DNA negative rate was 71% and the ALT normalization rate was 73%; and the 5-year HBV-DNA negative rate was 67% and the ALT normalization rate was 69%, showing that the efficacy of the drug became more pronounced as the duration of use increased. The incidence of drug resistance of ADV increases with the prolongation of drug use, which is 0% at 1 year and 28% at 5 years. 3, entecavir (ETV): cyclopentyl guanine nucleoside analog, anti-HBV activity is significantly better than LVD, safety, tolerability is similar to LVD, and has partial efficacy for LVD-resistant patients. A 1-year study in HbeAg-positive patients with chronic hepatitis B showed a 67% HBV-DNA negative rate, a 21% HbeAg seroconversion rate, a 68% ALT reversion rate, and a 72% liver histology improvement rate. A 1-year study of HbeAg-negative patients with chronic hepatitis B showed that the HBV-DNA negative rate was 90%, the ALT normalization rate was 70%, and the liver histology improvement rate was 70%. It can be seen that the antiviral activity of entecavir is relatively strong, and the resistance gene barrier is high, the initial treatment resistance rate is 0%, for LVD-resistant patients, the incidence of resistance at 1 year of treatment is 5.8%, and there is no cross-resistance with ADV.4. Tebivudine (LdT):Acting on HBV-DNA polymerase, it is a powerful and specific HBV inhibitor, a 2-year study of HbeAg-positive patients with slow hepatitis B A 2-year study in HbeAg-positive slow hepatitis B patients showed a 36% HbeAg seroconversion rate, while a 2-year study in HbeAg-negative slow hepatitis B patients showed an 82% HBV-DNA negative conversion rate. Therefore, LdT has a significantly lower rate of primary treatment failure and incidence of drug resistance compared to LVD, a high seroconversion rate, and is more effective in pushing HBV patients to the desired treatment endpoint. 5, Tenofovir (TDF): a cyclic nucleoside analogue, similar to ADV. A study of HbeAg-negative chronic hepatitis B patients treated with TDF and ADV for 1 year showed that the HBV-DNA negative conversion rate was 93% and 63%, and the histological improvement rate was 72% and 69%, respectively. 93% HBV-DNA negative conversion rate in LVD-resistant patients treated with TDF may become an effective treatment drug for LVD-resistant patients. 6, Clavadin: pyrimidine nucleoside analogues, long-acting anti-HBV agents, its reasonable dose and duration of treatment need to be further studied. In conclusion, for patients with primary treatment of hepatitis B with indications for antiviral therapy, all of the above drugs are first-line drugs and can be chosen, but there are more factors to consider in choosing drugs, which are more complex, including the patient’s own factors, drug factors, the patient’s degree of understanding of the disease and drugs, the patient’s degree of cooperation with the physician, and the patient’s financial ability. In general, the selection of drugs for patients with the same clinical type of hepatitis B should be considered in terms of intensity of viral suppression, hepatitis B e antigen seroconversion rate, incidence of drug resistance, drug price, and adverse effects.