Two hundred and four patients with biopsy-proven HBsAg-positive chronic active hepatitis were treated for at least 2 years with azathioprine, prednisolone or a combination of both, or were untreated. Prevalences of HBeAg, anti-HBe, and anti-HBc were 26, 58, and loo%, respectively. Criteria for improvement or progression of disease were based on clinical, biochemical, and morphologic parameters. Prednisolone therapy and combination therapy did not modify the course of the disease in HBeAg-positive patients; azathioprine therapy may have been deleterious for these patients. Among HBeAg-negative patients, deterioration or death occurred more frequently in those who were untreated than in those who received the combination of azathioprine and prednisolone. Prednisolone therapy was of moderate effect, whereas azathioprine did not influence the outcome.
The effect of long-term immunosuppressive therapy on HBsAg-positive chronic active hepatitis (CAH) is uncertain. Available reports are either limited or not randomized, and results are conflicting. Some authors report deleterious effect or no effectiveness or only moderate benefit (1-6), whereas other investigators are more optimistic (7,8). We conducted a prospective study of 204 patients with HBsAg-positive CAH; 153 were treated with azathioprine and/or prednisolone, and 51 were untreated. Patients were observed for at least 2 years, and the course of the disease was evaluated in relation to the presence or absence of serum HBeAg or anti-HBe at the initiation of the study.
MATERIALS AND METHODS CLINICAL MATERIAL
Two hundred and four consecutive patients with biopsy-proven HBsAg-positive CAH were included. CAH was diagnosed according to accepted criteria (9). Before