Patients with NAFLD and concomitant chronic hepatitis B are increasingly prevalent. Individually, both NAFLD and Chronic hepatitis B can impact on liver function and potentiate progressive disease and complications such as cirrhosis or hepatocellular carcinoma. In concurrent CHB-NAFLD, with the complex interplay between the two diseased entities, clinical characteristics may differ from patients with single disease. While hepatic steatosis is associated with diminished hepatitis B viral seromarker variables, paradoxically, concurrent disease appears to have a poorer overall outcome. Clinicians may encounter challenges in identifying predominant drivers of liver injury and choosing appropriate treatment. Treatment of chronic hepatitis B should proceed as indicated, but it is equally important to be vigilant about the other metabolic factors intertwined with the NAFLD component. As such, a multi-disciplinary holistic approach should be applied to patients with NAFLD and concomitant chronic hepatitis B. This presentation provides a review of current evidence and practical considerations in managing this disease.