Current concepts in the diagnosis and management of hepatitis B surface antigen-positive chronic active hepatitis.

Serologic manifestations of the hepatitis B virus are present in up to 25% of patients with chronic active hepatitis in the United States. Progression to cirrhosis and death from liver failure or malignancy are possible long-term consequences of this association. Corticosteroids have been less effective in managing B-related disease than non-B illness. Immunosuppressive treatment may actually facilitate viral replication and enhance morbidity and mortality. Virus-induced alterations of the hepatocyte probably trigger antigen-specific cytotoxic humoral and cellular immune responses that perpetuate liver injury. Treatments to interrupt these pathogenetic mechanisms include immunosuppression, antiviral therapy, immunostimulation, and antibody induction. Experiences with antiviral and immunostimulatory agents have shown some promise, but controlled observations are rare, and results have been inconsistent.