Treatment of chronic active hepatitis B (CAH B) with chloroquine: a preliminary report

Corticosteroids, azathioprine and antiviral agents have a questionable effect on CAH B. Chloroquine, a lysosomotropic agent, was used to treat 7 patients with histologically confirmed CAH B. All were HBeAb positive. A working hypothesis considering cellular death in CAH B as the result of lysosomal enzyme liberation by activated Kupffer cells was the basis for treatment. In this model T lymphocytes have only an immunoregulatory role. Clinical and laboratory follow-up was done for 6-16 months (median 12 months). Serum chloroquine levels were recorded by a fluorimetric method. 150-450 mg of chloroquine base were administered according to bio-chemical disease activity. In all patients AST and ALT values returned to normal and there was a fall in serum delta GT and improvement of prothrombin time. an increase of globulins was noted. Inadvertent drug withdrawal resulted in aminotransferase increase in 3 patients with prompt restoration of normal values on readministration. One patient refused to continue the drug and died after two months. Variceal bleeding was the cause of death of a second patient. No side effects were noted. A repeat liver biopsy, a year later (4 patients) revealed inactive cirrhosis in all. Chloroquine administration is a safe treatment for patients with CAH B. Further studies are justified.