In the process of clinical consultation, patients often encounter doctors who say “your hepatitis B is not much of a problem now and does not need treatment for the time being”, “your hepatitis B needs active antiviral treatment at the moment”, “you have cirrhosis of the liver now You need standardized antiviral and anti-fibrotic treatment” and many other suggestions. I feel that in order to understand and implement these treatment recommendations, it is important to understand the natural history of the course of hepatitis B virus (HBV) infection and the clinical prognosis. This is because it is important for patients to properly understand the disease, cooperate with doctors in treatment, and carry out lifestyle management. Generally speaking, the natural course of chronic HBV infection is divided into 3 different periods, namely the immune tolerance period, the immune clearance period, and the immune control period (HBV inactive replication period). However, it is influenced by many factors such as virus (genotype, viral genetic variation, virus-host gene integration), host (age of infection, gender, immune status, etc.), lifestyle habits (e.g. alcohol consumption, smoking), and available antiviral therapy. Immune tolerance phase: It occurs mainly in childhood infections as well as in younger adults. Since the main mode of HBV infection in China is mother-to-child transmission, it occurs in the vast majority of HBV-infected patients. The main characteristics of this period are: no clinical symptoms, HBeAg positive, normal liver function (there is a special case: ALT mildly elevated <80U/L, and the cause of its elevation is not related to HBV infection, but may be due to other reasons such as fatty liver, fatigue, etc.), high HBVDNA titer, usually more than 107 or 108. immune tolerance period can last for several years or even decades. Since HBV itself is not pathogenic to cells, most patients in this stage have no or only very mild liver inflammatory reaction and fibrosis. This stage is not suitable for antiviral therapy, because the body will not respond to antiviral therapy, the efficacy is poor, so the main focus is on disease monitoring. For those with mildly elevated ALT, liver protective and anti-inflammatory drugs can be taken appropriately. Immune clearance phase: This phase is characterized by elevated AIT levels, elevated HBV DNA and more than 104copies/mL, with significant liver inflammatory activity, often accompanied by liver fibrosis, which is caused by the cytotoxic effect of the body's immune system on infected HBV hepatocytes. Adults and those infected with HBV in adolescence enter the immune clearance phase soon after infection, but those with vertical transmission and those infected in early childhood take many years to enter the immune clearance phase. The immune clearance period mostly occurs at the age of 30 to 40 years and lasts for varying lengths of time. If the immune response is strong enough, patients may experience HBeAg serologic conversion (HBeAg negative with the appearance of anti-mono-HBe), and the disease enters a period of relative stability. However, in 10% to 30% of patients, even after HBeAg seroconversion, the disease is still in the active phase, as evidenced by an elevated AIT and HBV DNA >104copies/mL, which is what we call HBeAg-negative chronic hepatitis B. For chronic hepatitis B in the immune clearance phase, whether HBeAg positive or HBeAg negative, active standardized scientific antiviral treatment is needed, and the effect will be better if the economic conditions allow with anti-fibrotic treatment. Immunocontrol period (inactive replication period): HBeAg serological conversion accompanied by the emergence of anti-HBe, 70% to 80% of patients enter inactive replication, also called inactive HBsAg carrier state. It is characterized by the disappearance of HBeAg, the appearance of anti-one HBe, the continued normalization of ALT, and the continued HBV DNA below 104copies/mL or even negative. Long-term prospective follow-up of patients with inactive disease reveals that most liver inflammatory responses progress slowly or rarely continue to progress. Approximately 10% to 30% of patients who have entered the inactive phase experience one or more episodes of hepatitis or even a return to HBeAg-positive status during follow-up. The re-emergence of HBeAg-positive status may be genotype-related, with genotypes C and F recurring in up to >40% of patients. In patients with inactive replication, clearance of HBsAg occurs in approximately 0.5% to 1.0% of patients each year, and patients who do clear HBsAg are essentially stable for life. However, liver biopsies in such patients show the presence of HBV ccDNA in liver tissue, suggesting that once HBV has infected the host, it is likely to remain there for life. Therefore, for patients in the inactive phase, there is still a need to be alert to HBV reactivation during immunosuppression (certain diseases or drugs such as glucocorticoids) and chemotherapy. Monitoring of the disease needs to be strengthened during the immune control period, and active standardized anti-disease treatment is still required once an episode of hepatitis is detected. In contrast, for patients in the inactive replication phase, antiviral drugs are needed to prevent hepatitis B virus replication and hepatitis reactivation if prolonged use of glucocorticoids or chemotherapy, etc. is required.