I. Drug selection for patients with hepatitis B E antigen-positive chronic hepatitis B primary treatment: The ideal therapeutic endpoint for hepatitis B E antigen-positive patients is seroconversion of hepatitis B surface antigen, but this is often difficult to achieve. The alternative therapeutic endpoint is to achieve seroconversion of hepatitis B E antigen with undetectable hepatitis B viral DNA and reversion of aminotransferases, and therefore drugs should be selected according to this therapeutic endpoint. Interferon therapy should be preferred if it is available, and nucleoside analogs should be considered for those who have contraindications to interferon therapy, adverse reactions or affordability to use interferon therapy. Nucleoside analogs have a stronger inhibitory effect on HBV-DNA, so those with a high viral load have a preference for drugs with a stronger viral inhibitory effect, such as telbivudine or entecavir. Secondly, the lower conversion rate of hepatitis B E antigen after nucleoside analogue treatment requires longer-term treatment, and drug resistance and safety in long-term treatment are important factors in choosing drugs, in addition, price is also one of the considerations. Although entecavir has a high resistance barrier, the most expensive price limits its use as the drug of choice, and telbivudine with moderate price and high conversion rate of hepatitis B E antigen is the preferred drug for treating hepatitis B E antigen positivity. For hepatitis B E antigen-positive patients with low viral load, lamivudine can be chosen. The drug of choice for patients with hepatitis B E antigen-negative slow hepatitis B primary treatment: patients with hepatitis B E antigen-negative slow hepatitis B primary treatment are relatively older, have longer disease duration, lower viral load, heavier liver histological lesions and longer accumulation of lesions, thus more likely to develop into cirrhosis or liver cancer. The most basic therapeutic goal for patients with hepatitis B E antigen negative chronic hepatitis B should be to reduce HBV-DNA to undetectable levels and normalize ALT, and the endpoint of treatment is the disappearance of hepatitis B surface antigen, but it takes longer time, so it is clinically difficult to operate, and long-term maintenance therapy is currently recommended, so firstly, drugs with strong viral suppressive effect should be selected, and secondly, the incidence of drug resistance in long-term treatment should be considered. Entecavir is preferred for hepatitis B E antigen-negative chronic hepatitis B patients with high viral load, and adefovir is preferred for hepatitis B E antigen-negative chronic hepatitis B patients with low viral load. The incidence of lamivudine resistance is high and will be higher with long-term use; therefore, patients who do not develop a complete response should be promptly treated with a combination of adefovir to prevent and reduce the incidence of drug resistance. The goal of treatment for patients with hepatitis B cirrhosis and hepatocellular carcinoma is to prevent further progression of the disease by inhibiting viral replication and to prevent the occurrence of hepatic failure and hepatocellular carcinoma, which requires long-term antiviral therapy and carries a greater risk of dramatic worsening of the disease once the drug is discontinued and relapsed. A 3-year study of lamivudine in patients with compensated cirrhosis or severe liver fibrosis confirmed that lamivudine can effectively stop the progression of the disease and reduce the incidence of hepatocellular carcinoma, so lamivudine is one of the preferred drugs for the treatment of patients with compensated hepatitis B cirrhosis. Theoretically, other nucleoside analogues also have the same viral inhibitory effect and stop the progression of the disease, and their clinical efficacy is similar to that of lamivudine, which is the drug of choice for the treatment of compensated cirrhosis. The choice of lamivudine treatment for patients with decompensated cirrhosis is effective and safe. Adefovir has a high rate of renal damage after treatment and is not recommended as a first choice. Most patients with hepatocellular carcinoma have low levels of HBV-DNA and any nucleoside analogues can effectively inhibit the virus, but considering the patients’ condition, economic conditions and actual course of treatment, lamivudine is preferred and other drugs have relatively little clinical experience and are generally not used as drugs of choice. Drug selection for patients with nucleoside analogue resistance: Lamivudine resistant patients are preferred to be treated with adefovir, and alternating adefovir and switching to high dose entecavir therapy is not recommended. Adefovir-resistant patients may be switched to or combined with telbivudine, lamivudine or entecavir. Recent clinical studies have shown that switching to interferon therapy in patients with nucleoside analogue resistance may be an effective treatment option.