Chronic hepatitis B is a kind of immune hepatitis induced by the continuous replication of hepatitis B virus in the body, and the core treatment of chronic hepatitis B is antiviral therapy. Whether chronic hepatitis B patients need antiviral treatment requires clinicians to dynamically observe their conditions and comprehensively analyze various medical history data to make a more accurate judgment. Whether antiviral treatment is needed, it is most important to grasp two points. 1. To accurately determine the amount of hepatitis B virus replication in the patient’s body. Detecting the quantitative level of HBVDNA in the patient’s blood is the “gold standard” that objectively reflects the number of replication of hepatitis B virus, but due to the influence of the degree of hepatitis activity, detection methods and sensitivity of detection reagents, the quantitative level of HBVDNA at one time can not comprehensively and accurately respond to the number of replication of the virus in the patient’s body, and sometimes it is necessary to repeat multiple tests of HBVDNA. The quantitative level of HBVDNA can not fully and accurately reflect the amount of virus replication in the patient’s body, and sometimes it is necessary to test the quantitative level of HBVDNA several times, and it is better to use the imported Roche reagent COBAS test. 2. Comprehensively and accurately assess the past, present and future of the patient’s liver. To understand the past condition of the patient’s liver, mainly to understand the patient’s previous hepatitis attack and treatment medication, but also to understand the family history of liver disease, such as whether there are patients with cirrhosis and liver cancer in relatives. Accurately determining the patient’s current liver inflammation and fibrosis is the main basis for antiviral treatment, mainly through the analysis of their liver function, blood routine, AFP and ultrasound, CT, MRI, liver fibrosis scanning, etc., and if necessary, liver pathology examination. Never hastily assume that a patient’s liver is normal based on one or two normal liver function tests alone. After a thorough understanding of the past and present of the patient’s liver, it is important to objectively assess the risk of progression of his/her liver disease, whether there will be a loss of hepatic function in the near future, whether there will be significant inflammatory activity in the liver in the near future, and whether there is a high risk of cirrhosis or hepatocellular carcinoma developing in the future. Only by firmly grasping the two keys of viral replication and liver lesions can we make the right antiviral decision.