Development of antiviral resistance is a particular concern for the Advisory Committee on Antimicrobial Resistance and Healthcare-Associated Infections (ARHAI). Over the last 4 years, considerable time has been devoted to examining the ability of the UK to monitor the presence and transmission of antiviral resistance. Resistances to antiviral agents in influenza virus, HIV and hepatitis B and C viruses were identified as the main targets. The emphasis is on a network of laboratories that are able to perform diagnostic tests for resistance and to participate in surveillance programmes with co-ordination either through a central reference facility in the HPA or a collaborative study group.

Chronic hepatitis B (CHB) virus infection affects about 400 million people around the globe and is among the world's leading causes of death. The management of CHB has evolved rapidly, several therapeutic options are now available to prevent both progression of liver disease and anticipated liver morbidity and mortality.

Current treatment modalities for CHB patients, together with suggestions from our own experience are summarized. The most relevant works published in recent years on pegylated interferon, nucleos(t)ides analogues (NUC) and the 2009 update of the American Association for the Study of Liver Diseases Practice Guidelines and the 2009 European Association for the Study of the Liver (EASL) Clinical Practice Guidelines on the management of chronic hepatitis B are discussed.

Pegylated interferon and NUC have advantages and limitations, as short-term interferon treatment induces a sustained virological response in a third of patients, whereas long-term suppressive therapy by NUC rapidly inhibits HBV replication in most patients but drug resistance and safety in the long-term will remain the most important unresolved questions. Careful evaluation of patient history, staging of liver disease and virological factors should guide the start of treatment and the choice to the most appropriate individualized treatment strategy in all CHB patients.