Hepatitis B is one of the major diseases that threaten people’s health in China. Although there are antiviral drugs including interferon and various oral nucleoside (acid) drugs, the data from studies have shown that 4-5 years of oral nucleoside (acid) drug treatment only enables about 50% of patients to convert “major triplet” to “minor triplet”. “This means that another 50% of patients with “major triple-positive” disease are still unable to obtain satisfactory results after 6-7 years of oral antiviral therapy and stop taking the drugs. However, the majority of patients who do not experience “small triplet” conversion will definitely experience a relapse of hepatitis after stopping the drug, and in a few cases, liver failure will result from the relapse of hepatitis after stopping the drug, and in very few cases, the disease is even irreversible. For patients with “minor triplets”, there seems to be no reliable criteria for stopping the current nucleoside (acid) drugs, which means that long-term treatment is necessary. In fact, the main source of hepatitis B threatening people’s health is cirrhosis and possible liver cancer, and the domestic guidelines for hepatitis B management clearly state that the primary goal of hepatitis B treatment is to stop cirrhosis, liver cancer and death. The available studies on the natural history of hepatitis B show that the overall incidence of cirrhosis in chronic hepatitis B virus-infected patients is 30%, and the annual incidence of cirrhosis in inactive carriers of hepatitis B virus is less than 0.1%. The 5-year cumulative incidence of cirrhosis is 8% and 13% respectively; meaning that not all hepatitis B virus-infected patients will face the threat of cirrhosis and need to receive antiviral treatment. So, which hepatitis B virus-infected patients need antiviral treatment to stop cirrhosis and liver cancer from developing? We also often encounter the expectation of women who are facing the “task” of having children: can I get pregnant? We also get the anxious look from “mothers-to-be” who have hepatitis activity during pregnancy: Is it safe for me and my baby? In this regard, the doctor’s decision needs to take into account the following factors: Is the pregnant woman’s liver safe enough to protect the mother and baby in the presence of active hepatitis? There are no human studies to prove the absolute safety of oral hepatitis B medications for fetal development. Does the pregnant woman’s condition require treatment with oral antiviral medications to prevent the development of liver failure? What is the basis for answering the above questions? The patient’s liver fibrosis status. Liver fibrosis is the underlying lesion for the development of cirrhosis, and the continued development of liver fibrosis is a necessary mechanism for the development of cirrhosis, but not all liver fibrosis will evolve into cirrhosis. The question that arises is, which patients need timely treatment and should not be discontinued at will? In China, the diagnosis of liver fibrosis is divided into 4 stages: S1 is only fibrosis in the confluent area of the liver, which is harmless to the liver; S2 is a small amount of fibrosis has been interconnected and formed intervals, which is the basis for the formation of cirrhosis and needs to be alert; while S3 is more and more of these intervals have destroyed the normal structure of the liver, which is a prelude to cirrhosis and needs to be cleared in time; S4 is a sign of the formation of cirrhosis, which may be cleared in time. Timely cleaning may restore the vitality of the liver, but a few patients cannot avoid complications such as hepatocellular carcinoma and esophageal varices. Thus, it is clear that pre-treatment liver fibrosis assessment is an important clinical guideline for the management of hepatitis B patients: when patients cannot obtain the desired effect of antiviral therapy, patients with S2 or milder liver fibrosis are the ones who can be considered for discontinuation and observation; while liver fibrosis S3, which is allowed to develop without effective antiviral therapy, will eventually develop into cirrhosis, which is an important target that requires longer effective treatment to stop the development of lesions. The patients with cirrhosis should receive adequate antiviral treatment and obtain remission before considering pregnancy, and “mothers-to-be” with liver fibrosis S3 or cirrhosis should receive immediate and relatively safe “treatment”. Mothers-to-be” with liver fibrosis S3 or cirrhosis should immediately receive relatively safe antiviral treatment with tenofovir or telbivudine. In addition, thrombocytopenia, splenomegaly, albumin less than 35 g/L, prolonged prothrombin time more than 3 seconds without other explanations should be taken into account to exclude the presence of cirrhosis and, if necessary, a liver aspiration should be performed. However, it must be clear that the above-mentioned drugs are not effective drugs for hepatitis B treatment, and no effective treatment exists so far. Therefore, the decision of whether or not to administer antiviral therapy is not based solely on transaminase levels and virus levels, but more importantly, reference should be made to the status of liver fibrosis and comprehensive consideration of the patient’s virus level, degree of liver fibrosis, age, marriage, and financial ability. Especially before applying nucleoside (acid) drugs, patients should weigh the possible benefits of long-term treatment, financial ability and family factors before making treatment decisions. The extreme misconception that nucleoside (acid) drugs are “a cure for disease and a prevention of disease” should be eliminated.