For the treatment of chronic hepatitis B, tenofovir is able to maintain long-term viral suppression without the development of antiviral resistance. Long-term viral remission results in regression of fibrosis and even cirrhosis. With the availability of such effective antiviral agents, it has become even more important to identify patients with chronic hepatitis B, who are at risk for progression to cirrhosis and hepatocellular carcinoma. Nevertheless, the disadvantages of long-term treatment, including cost and safety, should be considered as well. In addition, treatment should only be provided in patients for whom a clear clinical benefit has been demonstrated.