In hepatitis B virus (HBV) infection, a single approach to treatment cannot be applied to all patients. Acute, adult-acquired HBV infection rarely requires treatment, whereas treatment for chronic infection should be based on the patient's clinical situation and test results. The ideal agent for treating hepatitis B does not exist, and trade-offs are the essence of agent selection. In last month's Journal (Cleve Clin J Med 2008; 75:881-889), we outlined the natural history and diagnosis of chronic HBV infection; in this article we outline its management.