Normal or low levels of ALT (within 2 times the normal value) often indicate that the liver tissue is not inflamed or that the degree of inflammation is mild. In the absence of liver inflammation, it often means that the patient’s body is still in a state of immune tolerance (i.e., the immune system has not launched an attack on the virus), and antiviral therapy, whether interferon or nucleoside analogs, is ineffective at this time. The need for antiviral therapy in this group of patients must be determined by combining HBV-DNA levels and histological inflammatory activity. The vast majority of experts believe that those with the following indications need antiviral therapy: 1. Normal or low levels of ALT, but imaging changes in the liver or spleen, such as thickening and less uniform distribution of light spots in liver tissue over time on ultrasound, and an enlarged spleen. In such cases, antiviral therapy is required to stop or delay disease progression. 2. Histological examination of the liver (liver puncture for biopsy) with inflammatory changes (Knodell HAI score ≥ 4, or ≥ G2 for inflammatory necrosis) requires antiviral therapy. Therefore, chronic hepatitis B carriers need regular ultrasound examination of the liver and spleen in addition to regular rechecking of liver function and HBV-DNA; ALT is mildly elevated, HBV-DNA values can be measured, and for those who are over 35 years old, it is best to have a liver puncture to assess liver inflammation and early antiviral treatment.