Treatment of chronic active hepatitis--present state

Nowadays, both Anglo-Saxon and Middle European pathologists define chronic active hepatitis as synonymous with chronic aggressive hepatitis (CAH) without cirrhotic transformation. For its treatment, an accurate determination of the histological stage is necessary. CAH with slight to moderate activity (type 2a) requires merely general treatment, while corticosteroids and/or immunosuppressives are contraindicated. The latter drugs are indicated only for HBs- and HBeAG-negative CAH of type 2b with marked inflammatory activity. Every case should, however, be carefully assessed to determine whether these drugs might not be contraindicated. Our own experience with more than 600 patients with CAH shows that the prognosis is most favourable in HBs- and HBeAg-negative patients, in whom pre-existing chronic infections have been quickly recognized and eradicated, and in whom corticosteroids and/or immunosuppressives were not required. In the meantime, 13% of the CAH patients without cirrhotic transformation have been cured, and 42.5% improved. In contrast, CAH treatment with interferon, Virazol, arabinoside and immunostimulation remain disappointing.