Diagnosis and treatment of autoimmune hepatitis

Abstract

Autoimmune hepatitis is a chronic, progressive disease, more frequent in women than in men, and of unknown etiology. Histologically, it is characterized by mononuclear cell infiltration in the portal tract, and biochemically by elevation of transaminases, hypergammaglobulinemia, and the presence of liver specific autoantibodies. Response to immunosuppressive treatment is generally good and the resolution of inflammation, both biochemically and histologically, is achieved in 87% of patients in 3 years after immunosuppressive treatment is started. Several studies have shown that in the absence of treatment the disease progresses rapidly to fibrosis, and the mortality rate is higher than 80% in the 5 years following diagnosis in untreated patients. Nevertheless, even if the patient has liver fibrosis, treatment decreases the inflammatory response and the histological progression of fibrosis. Life expectancy of patients who respond to treatment exceeds 90% at 10 years, and is 80% at 20 years; however, 10-15% of patients do not have satisfactory response to medical treatment. Standard treatment and new therapeutic options are reviewed in this article.