Hepatitis B virus (HBV) is a unique hepatotropic DNA virus that forms covalently closed circular DNA within the nucleus of hepatocytes and can partially integrate into the host genome, establishing the molecular basis for persistent viral infection. HBV infection and replication depends on multiple hepatocyte-enriched host factors and is modulated by the hepatic microenvironment. The host achieves natural control and clearance of HBV through various mechanisms, including cytolytic elimination mediated by cellular immunity such as cytotoxic T lymphocytes and natural killer cells, innate immunity and noncytolytic clearance driven by interferons and various cytokines, and antibody-mediated protection and clearance as part of humoral immune response. In addition, intracellular restriction factors and pathways, hepatocyte turnover through division and replacement, and changes in the hepatic microenvironment (such as the increase in matrix stiffness) collectively influence the efficiency and outcome of viral control and clearance. This article clarifies and elaborates on related mechanisms, so as to deepen the understanding of HBV chronicity, spontaneous resolution, and cure and provide a theoretical basis for optimizing clinical management and developing novel therapeutic strategies.