[Treatment of autoimmune chronic active hepatitis and of primary biliary cirrhosis]

Several subtypes of autoimmune chronic active hepatitis can be distinguished today, one variant of which seems to be associated with active hepatitis C virus infection. Except for the latter, all types respond well to immunosuppressive therapy with prednisone (+/- azathioprine). Therapy has been shown to prolong survival, but the disease nevertheless often progresses to cirrhosis. For conservative therapy of primary biliary cirrhosis, D-penicillamine is contraindicated and several immunosuppressants investigated are associated with unacceptable side effects; ursodeoxycholic acid, colchicine and perhaps methotrexate seem to be promising, but none has been proven to prolong survival. Therefore, patients with primary biliary cirrhosis should still be included in therapeutic trials. In the advanced stages of both diseases liver transplantation remains an effective therapy.