Recommendation 1: Patients with persistently normal ALT (alanine aminotransferase) levels should not be treated, but close follow-up and monitoring for hepatocellular hepatocellular carcinoma at 3- to 6-month intervals is required. Recommendation 2: Liver biopsy is recommended for patients with viremia and elevated ALT levels prior to treatment. In patients with ALT greater than or equal to 2 times the upper limit of normal (ULN), treatment may be initiated if the increased ALT persists (at least 1 month of continuous observation). Recommendation 3: Patients with positive serum HBVDNA and ALT ≥ 2 × ULN should be considered for treatment. So what drug or treatment regimen should be used? Lamivudine is recommended for patients with viremia (both HBeAg positive and negative adults and children) who have ALT >5×ULN and are at risk of hepatic failure, as the drug has a faster onset of action. Interferon is also an effective drug in patients with high ALT levels, but it is not recommended in this case because of the slow onset of action, the risk of patient decompensation, and the fact that interferon may also accelerate the rate of decompensation in patients with cirrhosis. For patients who are HBeAg positive and have ALT levels in the range of 2-5 x ULN, both interferon and lamivudine are available. In deciding which drug to use, physicians and patients need to consider the differences between the two in terms of duration of therapy, cost of treatment, and adverse effects. Treatment selection should be individualized and based on a combination of consideration of disease severity, history of liver disease activity, liver function, adverse effects of the drug, cost of treatment, and the patient’s wishes (see chart below). Recommendation 4: When patients have the choice of interferon or lamivudine treatment, lamivudine is recommended if considered from the perspective of developing hepatic dysfunction. Recommendation 5: ALT, HBeAg and/or HBVDNA quantification should be monitored at least once every 3 months during treatment. When interferon therapy is used, it is important to monitor for adverse effects. Recommendation 6: ALT levels and HBV markers (including HBVDNA) need to be monitored monthly for the first 3 months after the end of treatment for early relapse and every 3 months (for patients with cirrhosis and those with persistent positive HBeAg/HBVDNA) or 6 months (for those with treatment response) thereafter. For non-responders, further monitoring should be performed to determine if there is a delayed response and to plan for retreatment when indicated. Recommendation 7: Duration of interferon therapy and timing of discontinuation For HBeAg-positive patients, the recommended duration of interferon therapy is 4 to 6 months, regardless of whether a treatment response has occurred. For HBeAg-positive non-responders or HBeAg-negative patients, a 12-month course is more beneficial. It is recommended to continue follow-up for 6 to 12 months after the end of interferon therapy to observe whether there is a delayed response and to clarify whether the response is durable to determine whether retreatment or other treatment is needed. Recommendation 8: Duration of Lamivudine and Timing of Discontinuation For HBeAg-positive patients treated with lamivudine, the drug can be discontinued if HBVDNA disappearance accompanied by HBeAg seroconversion is detected at two examinations 6 months apart. For those patients who are still HBeAg positive after 1 year of lamivudine, individualized analysis based on the patient’s clinical/virological response and the severity of the disease is required before deciding to discontinue or continue treatment. In HBeAg-negative patients, it is not yet possible to determine the ideal course of therapy, and the endpoint of treatment needs to be determined based on the patient’s clinical response and the severity of liver disease. Recommendation 9: Lamivudine may be used in patients who are approaching hepatic decompensation or who have clear manifestations of decompensation. Patients with decompensated liver disease often require discontinuation or dose reduction of interferon, as it may lead to serious adverse effects. Recommendation 10: For patients with immunosuppression, lamivudine therapy is preferred, as interferon is often ineffective or even harmful in organ transplant patients. Patients who are HBsAg-positive and on immunosuppression or chemotherapy need to be monitored closely for viral rebound and lamivudine therapy must be started promptly before the onset of decompensation.