Hepatitis B virus (HBV) carriers refer to a group of people who are infected with the hepatitis B virus, but have no signs and symptoms of hepatitis, normal liver function, ultrasound and other tests, more than 3 consecutive follow-up visits within 1 year, serum ALT and AST are in the normal range, and liver histological examination is generally not significantly abnormal. This group does not need antiviral treatment, even if the HBV DNA quantification is very high and highly infectious, it is not an indication for antiviral treatment. About 90% of those infected with HBV by mother-to-child route or in infancy become chronic hepatitis B virus carriers. The chronic rate of HBV infection in adults is only less than 10%, and HBV infection in adults is more common with latent infection, and most of them can heal themselves without antiviral. Most adolescents with chronic HBV infection have normal liver function, no symptoms and no need for treatment. In adulthood, as the immune system strengthens and the body begins to clear HBV, the liver becomes inflamed, manifesting as elevated transaminases. At this point, we need to determine if the patient’s elevated transaminases are caused by HBV infection and exclude other causes such as: other types of viral hepatitis, fatty liver, drug-related hepatitis, autoimmune hepatitis, alcoholic hepatitis, hyperthyroidism, etc. resulting in abnormal liver function. When it is determined that the elevated transaminases are caused by the hepatitis B virus (transaminases above 80 U/L), antiviral therapy can be administered. Therefore, anti-hepatitis B virus is not started simply when HBV DNA is positive or simply when transaminases are elevated. Medication needs to be used in conjunction with the patient’s specific situation and under the guidance of a specialist.