CHRONIC HEPATITIS - WHAT IS ACTIVITY AND HOW SHOULD IT BE ASSESSED

Hepatitis means more than inflammation of the liver; it includes an es sential element of hepatocellular damage, itself probably mediated by the infiltrating lymphocytes(1). Correspondingly, the concept of activ ity takes into account both inflammatory infiltration and hepatocellul ar damage. Histological activity is important for the patient and the clinician because it provides a measure of severity of the hepatitis a t the time of biopsy not always matched by abnormal liver function tes ts(2). The idea that it might also influence prognosis led to the 1968 classification of chronic hepatitis into chronic persistent and chron ic active forms(3), with the subsequent addition of chronic lobular he patitis(4). The reasons have been discussed elsewhere(5-10); briefly t he principal reasons are the greatly increased knowledge of the hepati tis viruses, the observation that patients with chronic hepatitis C an d predominantly portal inflammation may nevertheless develop cirrhosis , and the omission of forms of liver damage other than piecemeal necro sis from the 1968 classification.