The paper analyzes the clinical course of hepatitis, laboratory and morphological changes in 312 patients with the disease in the presence of chronic opisthorchiasis, including 277 with chronic persistent hepatitis and 35 with chronic active hepatitis. The intensity of a hepatic inflammatory process depended on the duration and number of infections. The greatest changes were observed in superinfections, then in reinfections. They were less profound in primary infection. A picture of chronic active hepatitis with signs of dystrophy, necrobiosis, and necrosis of cells was revealed in patients with super infections by morphological studies. Sclerotic changes with focal destruction of the organ and abnormal reconstruction of the lobar architecture were most significant in patients with reinvasion. Hepatocytic dystrophy in the absence of inflammation was more common in prolonged opisthorchiasis with low infection rates. The findings suggest that opisthorchiasis-associated hepatitis should be included into the current classification.