Background: Guidelines reported that the patients infected with hepatitis B (HBV) need monitoring of disease progression and hepatocellular carcinoma (HCC) screening to reduce the risk of decompensated cirrhosis and HCC. The present study aimed to examine the rates and risk factors of adherence to guideline-recommended long-term monitoring and HCC surveillance in patients with chronic hepatitis B Virus (CHB) infection. Methods: We performed a retrospective study of outpatients with CHB infection who from the outpatient database of a Chinese hospital in 2018 by using the International Classification of Diseases revision 10 code and computer queries. The guideline-recommended long-term monitoring and HCC surveillance require to monitor ≥2 times during the2-year follow-up period. Results: We analyzed 402 eligible outpatients with CHB infection. The number and rates of guideline-recommended long-term monitoring and HCC surveillance annually were as follows: 171 (42.54%) for alanine aminotransferase (ALT) and hepatitis B virus DNA (HBV-DNA), 107 (26.62%) for HCC surveillance, and 103 (25.62%) for all examinations which including ALT, HBV-DNA, and HCC surveillance. Age (P=0.018), gender (P=0.010), outpatient visit times (P=0.036), and antiviral treatment (P=0.044) were associated with the guideline-recommended long-term monitoring of ALT and HBV-DNA. Antiviral treatment (P=0.003, P=0.002) and initial liver imaging (P<0.001, P<0.001) were associated with the guideline-recommended HCC surveillance and also the monitoring of all examination. Conclusions: The present study observed poor adherence to the guideline-recommended long-term monitoring and HCC surveillance in patients with CHB infection. Additional measures are needed to promote disease monitoring and achieve optimal HBV management.