丙氨酸转氨酶（ALT）正常的慢性乙型肝炎病毒（HBV）感染人群是否启动抗病毒治疗一直是关注的热点和难点。在药物可及性和可支付性越来越改善的情况下，对这一人群是否需要治疗仍需更多数据。无论HBeAg阳性或阴性，仍有相当一部分ALT正常的慢性HBV感染者有明显肝脏炎症和纤维化，甚至肝硬化，需要启动抗HBV治疗。应通过肝活组织学检查或无创诊断技术检出具有肝脏炎症和纤维化的人群及早进行治疗。“,”Whether to initiate antiviral therapy in chronic hepatitis B virus (HBV) infected population with normal alanine aminotransferase (ALT) is hot and difficult issue. Improvements in drug availability and affordability have paved the way for more data, which may become a medium for confirming whether this population needs antiviral treatment. Regardless of whether HBeAg is positive or negative, there are still a considerable number of patients with chronic HBV infection with normal ALT, who have obvious liver inflammation, fibrosis or cirrhosis and need to start antiviral therapy. Liver biopsy or non-invasive techniques can be used as diagnostic tools to begin an early treatment in population with liver fibrosis and inflammation.