Abstract
Chronic hepatitis B infection remains a significant cause of morbidity and mortality worldwide despite the availability of an effective vaccine. The clinical management of chronic hepatitis B infection is complex often requiring the use of nucleotide analogs as well as immune modulators. The natural history and response to therapy are affected by the presence of naturally occurring mutations in the HBV genome particularly those in the basal core promoter and precore sites. Understanding the role of these mutations in outcome of infection and response to therapy can enable physicians to customize management in order to achieve optimal clinical outcomes.