Fewer than 1% of chronic hepatitis B virus (HBV) infections per year are cured with antiviral treatment. This creates a need for long-term treatment, which poses challenges for patients and health systems. Since cure is accompanied by recovery of antiviral immunity, a combination of direct-acting antiviral agents and immunotherapy are likely to be required. Extensive efforts have been made to identify determinants of the failed immune response to HBV in patients with chronic infection. We review mechanisms of immune dysfunction in patients with chronic HBV infection, immunotherapy strategies in development and the challenges associated with successful implementation of immunotherapy.