S2132 Age-Stratified Profiles of Chronic Hepatitis B and C: Divergent Pathways of Disease Progression in the Aging Liver

Introduction: As life expectancy increases, chronic viral hepatitis presents a growing challenge among older adults. While hepatitis C virus (HCV) is known to accelerate hepatic fibrosis with age, the age-related course of hepatitis B virus (HBV) is less understood. Few studies have directly compared the age-associated progression of HBV and HCV. This study evaluates and contrasts the clinical and fibrotic profiles of younger and older adults with chronic HBV and HCV in a real-world healthcare setting. Methods: We conducted a retrospective cohort study of adult patients with chronic HBV or HCV in the NCH Healthcare System from January 2019 to April 2025. Patients were stratified into 2 age groups: 30–50 and 70–90 years. Data were extracted from electronic medical records. Quantitative variables were analyzed using the Mann–Whitney U test, and categorical variables using the chi-squared or Fisher’s exact test, as appropriate. Statistical significance was defined as P < 0.05. Results: A total of 149 patients were included: 25 with HBV (14 aged 30–50; 11 aged 70–90) and 124 with HCV (94 aged 30–50; 30 aged 70–90). The HBV and HCV cohorts were predominantly male (63% and 60%, respectively) and White (72% and 94%); these demographics were similar across age groups. In the HBV cohort, older adults had significantly higher creatinine (2.05 vs 0.85 mg/dL, P = 0.016), but no significant differences in liver complications or non-invasive fibrosis scores. In the HCV cohort, older patients had higher rates of cirrhosis (36.7% vs 8.5%, P < 0.001) and ascites (26.7% vs 5.3%, P = 0.003), along with elevated fibrosis scores (FIB-4: 2.86 vs 1.08, P < 0.001; APRI: 1.17 vs 0.46, P < 0.001). Additional lab findings in the older group included lower platelet counts (178 vs 245 × 10⁹/L, P = 0.003), higher international normalized ratio (1.2 vs 1.0, P = 0.049), and lower alanine aminotransferase (43 vs 65 U/L, P = 0.046). Conclusion: This study highlights distinct age-related disease patterns in chronic hepatitis B and C. In HCV patients, aging is linked to advanced fibrosis and hepatic decompensation, despite lower aminotransferase levels. In contrast, older HBV patients showed renal impairment without significant liver disease progression. These findings underscore the need for age-specific strategies: prioritizing early fibrosis detection in older HCV patients and monitoring renal function in elderly HBV patients. Personalized care remains essential to improving outcomes in an aging population affected by chronic viral hepatitis.