Treatment of chronic active hepatitis--present state. The pros and cons of immunosuppressive therapy

Chronic aggressive (active) hepatitis (CAH) is an extraordinarily multifaceted disease. If attempts are made to obtain objective evidence concerning the effectivity of therapeutic procedures, the proposed controlled studies are beset by virtually insoluble problems. Because of this it seems, in this particular case, legitimate to take account of retrospective studies based on sufficient numbers of cases. Corticoid monotherapy and combined corticoid and azathioprine therapy have proved effective for immunosuppression in CAH. While the effectivity of immunosuppressive therapy in HBsAg negative CAH is undisputed, it is questionable for HBsAg positive CAH. The fact, which is now indisputable, that the mortality rate of HBsAg positive CAH is increased by steroid treatment, is an unequivocal contraindication for the general application of immunosuppressive therapy in this disease-group. However, the use of such treatment should not be excluded on purely theoretical grounds in cases of HBsAg positive CAH with an unfavourable prognosis. The success, even with such patients, can be astonishing. Under certain circumstances indirect immunostimulation can be attempted for HBeAg positive CAH, which is at least partially successful in a large percentage of cases.