|Unfortunately, there are no effective cures for hepatitis B virus (HBV) ; currently available treatments, such as interferons and nucleoside/nucleotide analogues (NUCs), can suppress viral replication but cannot eradicate the virus. Therefore, decision to treat should be individualized based on balancing the risk (i.e., un-treated natural course, side effects from treatments, cost) and benefit of the treatment. Generally, patients with low viral load are considered as a group at low risk for developing hepatic complications. Therefore treatment are usually recommended for those who shows elevated HBV DNA levels. Yet, recent studies suggest treatment strategy should also consider the severity of liver disease, that cirrhotic patients may need antiviral therapy regardless of viral loads. Moreover, there is a controversy whether low viral loads observed during potent NUCs therapy needs attention. Herein, we will discuss recent evidences for the risk and benefit of antiviral therapy in cirrhotic patients who shows low level viremia, as well as those who shows low level viremia during potent NUCs therapy.