Major two-positive hepatitis B means positive hepatitis B surface antigen and positive hepatitis B e antigen. Hepatitis B surface antigen is a pathogenic marker of hepatitis B infection and is the earliest pathogenic marker that appears after infection with the hepatitis B virus, and hepatitis B surface antigen is positively correlated with hepatitis B virus DNA levels. Hepatitis B e antigen positive means that the hepatitis B virus is actively replicating and the replication is large. Hepatitis B major two-positive means chronic hepatitis B with positive e antigen and further improvement of liver function tests. If the liver function glutamate transaminase exceeds twice the upper limit of normal value and the hepatitis B virus replication is >20,000 IU/ml, active antiviral treatment is required, either interferon or nucleoside analogues can be chosen. If left untreated there is a risk of disease progression to cirrhosis or liver cancer.