Monitoring of hepatitis B virus (HBV) levels in serum plays an important role in the management of chronic hepatitis B in patients receiving lamivudine. We evaluated the usefulness of real-time quantitative polymerase chain reaction (TaqMan PCR) for the measurement of HBV DNA. The subjects were 22 patients with chronic hepatitis B treated with lamivudine for 4-12 months. HBV DNA was measured by TaqMan PCR. For comparison, HBV DNA was also measured in 88 sera by branched DNA (bDNA) assay, transcription-mediated amplification (TMA) assay, and Amplicor monitor test. Correlation was significant between the results of TaqMan PCR and those of the three other assays (r=0.630, 0.681, and 0.715, respectively; P<0.05). Of the 22 patients, HBV DNA was beneath the detection limit at the start of therapy in 4 (18%) on the bDNA assay, 3 (14%) on the TMA assay, 2 (9%) on the Amplicor test, and 0 (0%) on TaqMan PCR. Of the 19 patients for whom sera were available at 12 weeks of therapy, HBV DNA was not detected in 16 (84%) on the bDNA assay, 12 (63%) on the TMA assay, 6 (32%) on the Amplicor test, and 2 (11%) on TaqMan PCR. Tyrosine-methionine-aspartate-aspartate (YMDD) variants emerged in three patients; TaqMan PCR detected HBV DNA throughout treatment and revealed significantly increased viral loads before biochemical breakthrough. We conclude that monitoring of HBV by TaqMan PCR is useful for evaluating response to lamivudine treatment and for early detection of drug-resistant variants.