【Objective】To explore the effect of antiviral treatment and treatment adherence on the disease spectrum of patients with chronic hepatitis B virus（HBV）infection.【Methods】Data of patients with chronic HBV infection treated in the Department of Infectious Diseases of the Third Affiliated Hospital of Sun Yat-sen University in 2018 were retrospectively collected. According to the antiviral treatment history，the patients were divided into antiviral group（n = 460）and non-antiviral group（n = 1 240）；according to the treatment adherence，the patients were divided into standard antiviral group（n = 277）and non-standard antiviral group（n = 183）. The distribution of disease spectrum was compared between these two groups. Meanwhile，the differences of the proportion of disease spectrum were compared with previous data in 2011.【Results】The proportion of patients diagnosed as chronic hepatitis B（CHB）（moderate），CHB（severe），acute-on-chronic liver failure（ACLF）and cirrhosis（compensated stage）in antiviral group was significantly lower than that in non- antiviral group（P < 0.01），while the proportion of patients diagnosed as cirrhosis（decompensated stage）was higher than that in non-antiviral group（70% vs. 37.1%，P < 0.001）. The proportion of CHB（moderate），CHB（severe）and ACLF in the standard antiviral group was significantly lower than that in the non-standard antiviral group（P < 0.01），and the proportion of patients diagnosed as cirrhosis（decompensated stage）in the standard antiviral group was significantly higher than that in the non- standard antiviral group（P < 0.001）. There was a significant difference between the data of 2011 and those of 2018（P < 0.001）. Compared with that in 2011，the proportion of patients diagnosed with CHB（moderate） and CHB（severe）decreased in 2018（P < 0.05），while the proportion of ACLF increased significantly（11.8% vs. 16.9%， P < 0.001）. The proportion of hospitalized patients with hepatocellular carcinoma was significantly higher in 2018 than in 2011（19.5% vs. 10.5%，P < 0.001）. In 2018，the proportion of inpatients who have received antiviral therapy was higher than that in 2011（27.1% vs. 17.2%，P < 0.001），and the proportion of patients who had poor adherence was significantly higher than that in 2011（P = 0.003）.【Conclusions】Antiviral treatment can reduce the proportion of CHB patients hospitalized due to hepatitis activities，but the non-standard antiviral treatment increases the proportion of patients with CHB（severe）and ACLF. The number of patients with combined diagnosis of HCC is increasing.