Abstract: Chronic hepatitis B virus(HBV) infection is a state of interactions among HBV, the hepatocytes and the immune system of the patient. The natural course of chronic HBV infection is now thought as comprising 3 phases: immune tolerance, immune clearance\[HBeAg-positive chronic hepatitis\], carrier state, and now HBeAg-negative chronic hepatitis B is also considered as a particular phase. Understanding the natural history of chronic HBV infection is crucial in the management of HBV infected patients and underscores the need for long-term monitoring. Accumulating evidence indicates that antiviral therapy can prevent progression of HBV-related liver disease, particularly among patients with sustained response. Pegylated interferon(IFN) and newer nucleos(t)ide analogues may have even better long-term outcomes because of better therapeutic efficacy and/or a low risk of drug resistances. The treatment outcomes are still far from satisfactory. The development of safe and affordable anti-HBV agents or strategies is needed to further improve outcomes.

Key words: hepatitis B virus, liver cirrhosis, hepatocellular carcinoma, antiviral, natural history