Autoimmune hepatitis in India: single tertiary referral centre experience

Area of Science:

• Hepatology
• Immunology
• Internal Medicine

Background:

• Autoimmune hepatitis (AIH) is perceived as rare in the Asia-Pacific region, with limited long-term data.
• This study addresses the need for understanding AIH burden and natural history in this population.

Purpose of the Study:

• To estimate the prevalence and burden of autoimmune hepatitis (AIH) in a single tertiary referral center.
• To describe the natural history, clinical presentation, and management challenges of AIH.
• To evaluate treatment outcomes and long-term prognosis in AIH patients.

Main Methods:

• A prospective database of patients treated for AIH was screened.
• 125 patients meeting simplified criteria for AIH, with substantial follow-up, were included.
• Data on clinical presentation, treatment, and outcomes were analyzed.

Main Results:

• AIH prevalence was 1.3% among all liver disease patients and 8.74% among chronic liver disease patients.
• Presentations varied, including acute liver failure, chronic hepatitis, and cirrhosis; 60% achieved remission after initial immunosuppression.
• After a median 7-year follow-up, 15 patients died (12 from liver complications), and 2 underwent transplantation; persistent ALT elevation predicted poor outcomes.

Conclusions:

• Autoimmune hepatitis (AIH), while uncommon, is a significant diagnosis in the Asia-Pacific region.
• Early diagnosis and treatment of AIH are crucial for achieving good long-term prognosis and potentially reversing cirrhosis.
• Management requires careful consideration of immunosuppression, particularly in severe cases.