Autoimmune hepatitis in a Jamaican cohort spanning 40 years

The prevalence and characteristics of autoimmune hepatitis (AIH) in black populations are not well documented.

To describe the clinical and laboratory features of AIH in patients presenting at a Jamaican hospital, 1969-2009.

A retrospective review of hospital records was done and patients were classified by the revised international scoring system.

Fifty patients satisfied criteria for diagnosis of AIH type-1 and most presented late at hospital. Almost one third of cases presented with chronic liver disease (32%) while 8% presented with fulminant hepatic failure and 2% with acute liver disease. Jaundice (92%) was the most common presenting feature. Other associated autoimmune diseases (10%) systemic lupus erythematosus and insulin dependent diabetes mellitus, were found. All patients (100%) had abnormal liver biochemical tests, 81% had hypergammaglobulinaemia and 82% AIH associated autoantibodies. The prevalence of autoantibodies increased with age (P=0.05). Liver biopsy, performed in 33 cases, showed chronic hepatitis (45%), cirrhosis (24%) chronic hepatitis with bridging necrosis (15%), chronic hepatitis with rosetting (6%) and nonspecific findings (10%). Patients were treated with prednisone with or without azathioprine. Relapse occurred in 4% and death 6%.

Autoimmune hepatitis is rare in Jamaicans and prognosis is similar to that reported in developed countries.