Diagnosis and treatment-autoimmune hepatitis (AIH)

(J Hepatol 2015;63:1543, Clin Liver Dis 2015;19:57)

• 70% female; bimodal presentation in the second and fifth decades of life

• 40% present w/ severe AIH (3% ALF) w/ ALT >10 × ULN; 34–45% asx

• Extrahepatic syndromes: thyroiditis, arthritis, UC, Sjögren’s, Coombs’ ⊕ anemia, celiac

• Dx: scoring system combining serologies, ↑ IgG, Ø viral hepatitis, & liver bx (interface hepatitis & lymphoplasmacytic infiltrate) has high Sp & mod Se (Dig Dis 2015;33[S2]:53)

• Rx: (1) ALT or AST >10× ULN (2) IgG >2× ULN + ALT >5× ULN (3) bridging/multiacinar necrosis (4) cirrhosis w/ inflammation on biopsy (5) AST/ALT >2x ULN + symptoms

• Induction Rx: (1) prednisone monoRx; (2) prednisone + AZA, or (3) budesonide (if non-cirrhotic) + AZA → 65–80% remission (asx, nl LFTs, bili, & IgG, none-to-minimal interface hepatitis); taper steroids as able; relapse rate of 50–80% (J Hep 2015;62:S100)

• Nonresponders or AZA intolerant: cyclosporine, tacrolimus, MMF, rituximab, infliximab