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, 10 (12), 911-923

Autoimmune Hepatitis: Appraisal of Current Treatment Guidelines


Autoimmune Hepatitis: Appraisal of Current Treatment Guidelines

Dhruv Lowe et al. World J Hepatol.


Autoimmune hepatitis affects patients of all ages and gender, across all geographic regions. Although still rare, its incidence and prevalence are increasing. Genetic predisposition conveyed by human leucocyte antigen is a strong risk factor for the disease and may be responsible in part for the wide variation in presentation in different geographic regions. Our understanding of the underlying pathogenic mechanisms is evolving and may lead to development of more targeted immunotherapies. Diagnosis is based on elevated levels of serum aminotransferases, gamma globulins, autoantibodies and characteristic findings on histology. Exclusion of other causes of chronic hepatitis is important. Although undiagnosed disease is associated with poor outcomes, it is readily treatable with timely immunosuppressive therapy in the majority of patients. International guidelines are available to guide management but there exists a disparity in the standard treatment regimens. This minireview aims to review the available guidelines and summarize the key recommendations involved in management of this complex autoimmune disease.

Keywords: Autoantibodies; Autoimmune hepatitis; Azathioprine; Hypergammaglobulinemia; Treatment.

Conflict of interest statement

Conflict-of-interest statement: Lowe D and John S do not have any affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter pertaining to this manuscript.


Figure 1
Figure 1
Algorithm for decision making regarding initiation of induction immunosuppressive therapy. Patients with active disease and advanced fibrosis/cirrhosis need initiation of therapy. Patients with mild or asymptomatic disease need an individualized approach. Patients with cirrhosis who have decompensated disease or no inflammatory activity on histology do no benefit from treatment. AIH: Autoimmune hepatitis; ALT: Alanine aminotransferase; ULN: Upper limit of normal; HAI: Hepatic activity index[4].
Figure 2
Figure 2
Treatment strategy in autoimmune hepatitis. Treatment includes induction and maintenance therapy to achieve biochemical remission. Induction is achieved by steroids and after a positive response (more than 25% reduction in serum aminotransferases after two weeks) is seen, azathioprine is introduced to achieve long term remission. Timely and appropriate maintenance therapy with azathioprine allows for steroid withdrawal. AIH: Autoimmune hepatitis; ALT: Alanine aminotransferase; CBC: Complete blood count; MMF: Mycophenolate mofetil; LT: Liver transplant[4].

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