A high rate of hepatitis B surface antigen (HBsAg) seroclearance after cessation of nucleoside therapy has been reported previously in patients with hepatitis B e antigen (HBeAg)-negative chronic hepatitis B.1–3 More important, patients who were not retreated for clinical relapses off medication had a much higher HBsAg seroclearance rate than those who received retreatment.1,3 These findings have raised an important issue of how to differentiate a benign or beneficial alanine aminotransferase (ALT) flare that retreatment can be withheld from a detrimental one that requires retreatment.