Current problems in the diagnosis and management of chronic active hepatitis

Although corticosteroids have been shown to be effective in the treatment of most forms of severe chronic active hepatitis, many problems remain in the diagnosis and management of patients with this disease. Difficulties in determining chronicity, establishing the correct diagnosis, and deciding when and how to initiate and stop therapy jeopardize successful management. Mechanisms of drug action, pharmacokinetics, long-term sequelae of therapy, and optimum treatment schedules have been incompletely described. A satisfactory program of management remains undefined for patients with less than severe disease, hepatitis B surface antigenemia, and suboptimal results after conventional treatment. The goals of this review are to identify problem areas and to indicate directions for future investigation and improvement.