[Cirrhosis secondary to chronic autoimmune hepatitis]

Cirrhosis is the usual end-result of chronic active autoimmune hepatitis. Different immunological abnormalities divide chronic active hepatitis into 3 subgroups: type I with anti-smooth muscle antibody; type II with anti-liver/kidney microsome antibody type 1 (anti-LKM1 antibody) and type III with an antibody directed against a soluble hepatic antigen. Three quarters of the patients are young women. The liver disease is often diagnosed at the stage of chronic active hepatitis, during evaluation of the subject's general condition or during investigations for an episode of jaundice; it is seldom diagnosed at the stage of constituted or decompensated cirrhosis. Fulminant forms are rare. Extrahepatic autoimmune manifestations are frequently encountered. Treatment relies on immunosuppressants, in practice corticosteroids. Corticosteroid therapy significantly prolongs the patient's life, but it does not prevent the passage to cirrhosis. In the long term these patients are exposed to all the complications of cirrhosis, notably the occurrence of hepatocellular carcinoma.