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Cirrhosis due to chronic infection with hepatitis B virus (HBV) is associated with decreased survival. Treatment options for patients with this disorder have been limited until recently. Interferon is contraindicated in patients with Child Pugh B or C status cirrhosis and even carries risk in patients with milder decompensation. A number of studies have shown that lamivudine is well tolerated and often improves the liver function and clinical status of patients with decompensated cirrhosis. The major problem with lamivudine when used as monotherapy is the unacceptably high rate of drug resistance. There are, however, a number of alternative nucleosides with activity against wild type as well as lamivudine resistant HBV which will undoubtedly have a major therapeutic role in the future