Chronic hepatitis B (CHB) is a major worldwide cause of chronic liver disease and a significant public health issue. Three predominant clinical presentations are recognized: hepatitis B e antigen(HBeAg) or typical CHB, HBeAg-negative or atypical CHB, and inactive CHB. The natural history of CHB infection in an individual may be dominated by one or a combination of these clinical presentations in a sequential fashion. These variations in clinical presentations reflect the viral-host immunology dynamics that form the basis for the development of liver disease. Therapy has been problematic in the past. There are three licensed drugs available for therapy of CHB with varied mechanisms of action. This has introduced the concept of tailored therapy for the individual patient. Many promising new agents and therapeutic approaches should become available in the near future.