Autoimmune hepatitis is an uncommon chronic immunological disorder occurs when the host immune system produces antibodies against its own liver cells. It is characterized by elevation of aminotransferases and autoantibodies; hypergammaglobulinemia, and interface hepatitis. The accurate cause of this disorder has not been entirely interpreted, but expert believes that genetic circumstantial and environmental factors may contribute to its progression. Previously, it is distinguished as lupoid hepatitis. It affects all ages of all races group in the world and predominantly young women are more prone to this disorder.
Autoimmune hepatitis is classified as type 1 or type 2, according to differences in their autoantibodies. Type 1 has prevalence of anti-smooth muscle antibodies and type 2 has prevalence of anti-liver kidney microsome 1. Type 1 disease is the major among in adult and type 2 is most common in children and young people.
Can Autoimmune Hepatitis Go Away?
With appropriate treatment, most of the patients can attain remission within 18 months. Statistic report says that 80% of the individuals successful recovered within 3 years. After recovering, prescribed medicine must be withdrawn cautiously. In many cases, the patients may relapse (recurrence) after cessation of immunosuppression particularly those with type 2 autoimmune hepatitis (characterized by anti-liver kidney microsome 1) in whom immunosuppression should probably never be stopped. In case of a relapse, repeat treatment with steroids is indicated, which is then followed by maintenance therapy throughout the life of the patient.
Management of Autoimmune hepatitis
The objective of treatment is to make the disorder to reduce and prevent subsequent difficulties of chronic hepatitis, such as cirrhosis and hepatocellular carcinoma. The American Association for the Study of Liver Disease guidelines has defined remission as the stage of the disease when there are no symptoms observed and there is complete normalization of all the laboratory investigations pertaining to liver functions and there is no sign of scarring of the liver or in other words cirrhosis.
How To Treat Autoimmune Hepatitis?
Corticosteroids have been used for more than 40 years to treat autoimmune hepatitis. Prednisolone (steroids) and azathioprine are accepted prescription for autoimmune hepatitis. Standard therapy according to the guidelines provided is by high doses of steroids for inducing remission, which is then tapered gradually and then azathioprine is added to the regimen. Sometimes, mycophenolate can be used as second-line therapy in patients who fails to respond to azathioprine.
Calcineurin inhibitors have shown some efficacy in treatment of autoimmune hepatitis but the use of tacrolimus is still a matter of debate with regard to its efficacy. There are no clinical trial data to support the use of rapamycin or rituximab in autoimmune hepatitis.
Difficulties In The Management Of Autoimmune Hepatitis
About 9% of treatment failure cases were observed in patients who have taken steroids and azathioprine. It is common that patients with autoimmune hepatitis present with fulminant hepatic failure. The presence of cirrhosis at the time of starting treatment confers a higher risk of treatment failure. AIH presenting during pregnancy is also challenging to manage. Sometimes, autoimmune hepatitis can coexist with other liver diseases, which does not respond well to immunosuppression.
Some patients may fail to respond to conventional therapy or may be intolerant of standard treatment regimes. A complete failure to respond to initial high-dose corticosteroids is uncommon. Biological therapies are currently coming onto the market which has a potential role in treating several autoimmune diseases. Anticytokine therapies, Rituximab (monoclonal antibody to CD20), TNF blockers, Anti-chemokine therapy, and Modulation of T-cell activation are some of the agents/method successfully involved in treating autoimmune hepatitis.
The majority of patients responds to conventional treatment with corticosteroids and azathioprine and has a good prognosis. With appropriate treatment, most of the patients can attain remission within 18 months. Statistic report says that 80% of the individuals successful recovered within 3 years. New drugs/therapies are promising for patients who fail to respond to conventional therapy or standard treatment regimes.
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