Contrasting features and responses to treatment of severe chronic active liver disease with and without hepatitis BS antigen.

Abstract

SUMMARY To determine the clinical implications of HBsAg in severe chronic active liver disease (CALD), patients with HB.Ag positive CALD were compared with those chosen by identical clinical, functional, and morphological criteria in whom this test and anti-HB5 were negative. HB8Ag positive patients were predominantly males over 40 years of age and more frequently failed to respond to conventional treatment programmes with prednisone. HBsAg negative patients were more often female and younger, had a higher incidence of associated immunopathic disease and immunoserological markers in high titre, and more often responded to treatment with full remission of their disease. HBsAg positive patients failing treatment with conventional doses of prednisone often improved with higher doses, but did not reach full remission of their disease. The benefit-risk ratio of both conventional and high doses of prednisone in HBsAg positive severe CALD needs further clarification.

The diagnosis of cirrhosis: clinical relevance and methodology

“…In the nineties, it has become increasingly apparent that the stage of cirrhosis is a key factor for defining prognosis and management; this is similar to the situation in the seventies when the etiology of the liver disease emerged as a clinically important factor for prognosis and response to therapy (3). With regard to prognosis, mortality in long-term follow-up studies of 'chronic active hepatitis' is confined mainly to patients with cirrhosis at entry (4 cholangitis (PBC) treated with ursodeoxycholic acid for 5 years confirmed the finding that mortality and clinical complications of liver disease occurred predominantly in those with cirrhosis (5).…”

Chronic active hepatitis: a sixteen year survey at a district general hospital

“…Investigations relating to aetiology are shown in Table I Twenty four subjects were treated with steroids (30-60 mg prednisolone daily) and, of these, 15 were steroid responsive using clinical and biochemical criteria, although 6 required the addition of azathio- …”

“…'-5 Although the crucial studies at the start ofthe last decade defined the condition and established appropriate treatment regimes, certain aspects of the condition, as seen in a non-referral centre, have not been emphasized despite increasing knowledge of the pathogenesis of CAH. [5][6][7][8] The present study establishes the incidence of the condition in a defined population, assesses changes in the pattern of inci' -nce, measures long-term prognosis and tre, lient outcome, and categorizes the aetioloey in ilis non-referral population. Figure 1.…”

Strategies in the Management of Chronic Active Hepatitis

“…Retrospective analyses and inadequately controlled prospective studies have suggested that corticosteroid therapy may increase the survival of patients with severe inflamma tory activity [19,35], Additionally, patients with severe disease have been found to have low levels of virus replication which are not enhanced by the long-term administration of corticosteroids [36], These patients may also have autoimmune, possibly corticosteroidresponsive, cytodestructive mechanisms con tributing to their illness [26]. Limited experi ences in patients with active virus propaga tion have even suggested that rapid with drawal of corticosteroids may potentiate an immune reaction which facilitates serocon version from HBeAG to antiHBe [37].…”