A Caucasian male aged 54 year was referred to our liver centre for the management of HBV-related cirrhosis. Prior treatment with recombinant alpha-interferon followed by lymphoblastoid interferon was only temporarily effective and the patient refused antiviral treatment with lamivudine. When admitted to our unit, the patient had a Child-Pugh score of A6, high HBV DNA load (4 x 10(6) IU/ml) and evidence of cirrhotic cardiomyopathy. Hepatic venous pressure gradient (HVPG) was 29mm Hg, indicative of clinically severe portal hypertension. Following 3 months of treatment with entecavir, tests for HBV DNA were negative, and 9 months after therapy started, HVPG was measured as 24mm Hg, a reduction from baseline of 17%. These findings indicate that sustained suppression of HBV DNA replication by entecavir in compensated cirrhosis with severe portal hypertension leads to a portal pressure reduction, without the need for vaso-active drugs, as measured using the transjugular HVPG approach described here.