Chronic hepatitis B (HBV) is a potentially serious disease that can lead to cirrhosis, liver failure, and hepatocellular carcinoma. It is estimated that 350- 400 million people worldwide are infected with chronic HBV (1) with 500,000 deaths per year due to complications (2). In the United States there are an estimated 1.25 million people with chronic HBV, but this estimate fails to take into account immigrants from endemic regions and persons who are incarcerated (3). Chronic HBV is diagnosed by the presence of hepatitis B surface antigen (HBsAg) in serum on two occasions separated by six months. Several effective pharmacologic therapies are available for use in treatment; however, who and how to treat can be complicated and confusing given the variability in disease progression, variable individual patient response, and the different advantages and disadvantages of each treatment modality. Patient selection is the key to having the best chance at a remission or cure with treatment. Which patients to treat is further complicated by several recent consensus statements and the 2007 AASLD guidelines, all of which have subtle differences on who and how to treat (4�8). Additionally, a recent appraisal of treatment strategies for hepatitis B found disagreement even among experts in the field (9). The criteria used to select patients for treatment are based on serologic, virologic, and histologic parameters.