Rationale, aims and objectives: Epidemiologic data regarding chronic hepatitis B virus infections in Israel is limited as large population-based study have not been performed. This work aimed to evaluate the current characteristics of hepatitis B infection among Israeli adults, and to evaluate adherence to European Association for the Study of the Liver practice guidelines for antiviral treatment. Methods: Clinical and demographic data of HBsAg-positive patients registered in the Leumit-Health-Service database (one of the four major health maintenance organizations in Israel) between 2000-2019 were retrieved. Patients were compared according to eligibility to antiviral treatment and type of nucleos(t)ide analogue (NA) treatment. Results: In total, 1216 patients had documented HBsAg positivity (males 58.6%, mean age 40.2±14.2 years), 90.6% of whom were HBeAg negative. Antiviral therapy eligibility was met by 37% of patients, among whom 89% received antiviral therapy. Antiviral therapies include NA with a high barrier to resistance (HBR) (64.5%) (entecavir 36.3% and tenofovir 28.2%) and NA with a low barrier to resistance (LBR) (35.5%) (adefovir 1.7% and lamivudine 33.8%). Compared to patients who received LBR NA, patients receiving HBR NA had shorter treatment (68.7±50vs.161.5±42.6 months, p<0.0001) and follow-up duration (125±68vs.188±48 months, p<0.0001); at the end of follow-up, ALT levels and APRI score were higher among patients on LBR NA compared to patients on HBR NA. Conclusion: Most patients received antiviral treatment according to the international practice guidelines. However, one-third of them were treated with a less potent NA, probably due to their lower cost. These findings should encourage the optimization of HBV care and full compliance with the professional practice guidelines recommendations.