Objective Antiviral treatments could benefit chronic hepatitis B (CHB) patients with the regression or improvement of liver fibrosis. However, the dynamic changes of liver fibrosis degree have not been clarified in patients unsatisfying the criteria of initiating antiviral treatment. The current study was to observe the long-term variation of liver stiffness measurement (LSM), virological and biochemical response on these patients without standard antiviral therapy.Methods A total of 220 patients who were diagnosed with chronic HBV infection, and did not reach the standard of antiviral therapy and completed follow-up date of more than 2 years in the First Affiliated Hospital of Xi’an Jiaotong University from 2012 to 2018 were enrolled retrospectively. According to the changes of LSM in baseline and follow-up period, the patients were divided into regression group, non-progressive group, and progressive group. The virological and biochemical characteristics of each group were analyzed.Results Among the 220 patients, 153 patients (69.5%) had no progress in LSM degree. Alanine aminotransferase (ALT), HBV DNA, and HBsAg in a few patients increased or slightly decreased, while the vast majority remained in a relative stable state. 89.5% (137/153) of the non-progressive patients were in grade F0. In addition, 58 patients showed spontaneous improvement with the decreasing rate of 0.460 kPa per year. Patients with ALT of 1-2 ULN had a statistically significant decrease in LSM improvement compared to patients with normal ALT. 82.8% of the LSM-improving patients showed baseline LSM of F1-F3. Only 9 patients showed LSM deterioration, however, which could not be explained by virus replication or necroinflammatory activity. Conclusions For patients unsatisfying standard antiviral therapy, most patients with baseline LSM of F0 grade don’t progress, and patients with baseline LSM of F1-F3 show a decrease during follow-up, LSM progression occurs in 4.1% of patients.