The goal of antiviral therapy in HBV cirrhotic patients is to prevent progression of the disease to decompensated cirrhosis, end-stage liver disease, hepatocellular carcinoma and death. This goal can be achieved if HBV replication can be suppressed, leading to biochemical remission, histological improvement and prevention of complications. If finite treatment with pegylated interferon is not contraindicated in compensated cirrhosis, long-term treatment with nucleoside/nucleotide analogues is recommended in patients with HBV-related cirrhosis, especially in decompensated cirrhosis. Patients with cirrhosis require careful monitoring to detect resistance and prevent flares, and also to screen for hepatocellular carcinoma, portal hypertension and liver failure.