Abstract: Objective To explore the clinical characteristics of chronic hepatitis B virus (HBV) infection in the aged. Methods Total of 53 cases with chronic HBV infection in the aged (＞ 60 years) were compared with 53 younger cases (13-58 years old, mean age 30.9 years) in gender, disease spectrum, serum level of HBV DNA and alanine aminotransferanse (ALT). Results Among the older cases, 35 cases (66.0%) are inactive HBsAg carrier, six (11.3%) are chronic hepatitis B patients with HBeAg positive, fi ve (9.4%) are chronic hepatitis B patients with HBeAg negative, seven (13.2%) are cirrhosis related to chronic hepatitis B, with a greatly different disease spectrum of those in younger cases with chronic HBV infection (P ＜ 0.01). The average serum HBV DNA (6.94 ± 5.92) × 106 copies/ml and ALT (30.8 ± 16.5) U/L in old cases are obviously lower than that in younger cases, (1.54 ± 1.21) × 107 copies/ml and (83.8 ± 62.5) U/L respectively. There is no obviously gender difference between the older and younger cases. Conclusions Four common chronic hepatitis B were observed in the cases with chronic HBV infection in the aged but active HBsAg carrier accounted for majority of disease spectrums. HBV replication and liver histological infl ammation do in older patients with chronic HBV infection, especially in those with HBeAg positive or negativeand chroinc hepatitis B and cirrhosis.