Heterogeneity of CAH

It was realized in the early 1970s that 'chronic active hepatitis' was a generic term for a liver disease with a variable expression and etiology. The hepatitis B surface antigen (HBsAg) had been identified as a marker of infection with hepatitis B virus (HBV), so that some cases of CAH could be characterized as HBV-associated CAH, in addition to autoimmunity and other causes.

Several categories of CAH can now be listed, as follows: 1) The archetypic CAH described in the 1950s as lupoid hepatitis, and now identifiable by autoimmune serological markers; 2) CAH due to persistence of hepatitis B virus (HBV) in the liver, marked (usually) by the presence of HBsAg in serum; 3) CAH due to persistence in the liver of hepatitis C virus (HCV); 4) CAH due to persisting immune-

mediated hepatitic reactions to a drug; 5) histological CAH in accompaniment with liver diseases of known toxic, genetic or metabolic cause; 6) a category with neither autoimmune nor viral markers, nor any identifiable cause, referred to as 'cryptogenic'. The relative frequency among populations of these categories of CAH varies. Chronic active hepatitis due to virus infection (HBV, HCV) is now numerically more frequent overall than the autoimmune type and, in some localities, virus-related CAH is seen almost exclusively.

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