Reviewed By: Pramod Kerkar, MD, FFARCSI

Autoimmune hepatitis is a disorder of unidentified etiology, causing acute and chronic liver disease. The prevalence rate of this disorder is 16.9 per 100,000 and annual occurrence of 1.9–3 per 100,000. It affects all ages and races, particularly black patients may have worse outcomes. It is characterized by a female preponderance and women are affected three times more commonly than men.

Can you Spread Autoimmune Hepatitis?

Autoimmune hepatitis is not contagious. It cannot spread from one person or organism to another, typically by direct contact. It is an autoimmune disease i.e. they occur when the immune cells in the body produce antibodies against its own cells and attack them. These antibodies are referred to as “auto-antibodies”. It is often initially asymptomatic and leads to chronic hepatitis if untreated. Most cases either progress rapidly to liver failure or become chronic with progression through cirrhosis to liver failure.

How Does it Occur?

Autoimmune hepatitis occurs in patients who have systemic autoimmune conditions such as celiac disease, vasculitis, and autoimmune thyroiditis. 60% of patients have chronic hepatitis that may mimic viral hepatitis, but without serologic evidence of a viral infection. The disease is strongly associated with anti-smooth muscle autoantibodies. There is currently no conclusive evidence as to any specific cause.

It is characterized by a T-cell rich interface hepatitis that contains B cells and plasma cells associated with hypergammaglobulinemia and autoantibody production. There is strong evidence that autoimmune hepatitis is driven by antigen-specific T cells that expand as a consequence of a failure of immune tolerance, particularly in type 2 autoimmune hepatitis in which the T- and B-cell autoantigen has been defined as a hepatic cytochrome CYP2D6.

Types of Autoimmune Hepatitis

Two types of autoimmune hepatitis are recognized according to seropositivity (results of a blood test). Smooth muscle antibody and/or antinuclear antibody define the type 1 and antibodies to liver-kidney microsome type 1 and/or liver cytosol type 1 defines type 2 autoimmune hepatitis. Type 1 affects both adults and children, while type 2 is mainly a pediatric disease, though it does occasionally affect young adults.

How Autoimmune Disease is Diagnosed?

The criteria for the diagnosis of autoimmune hepatitis have been established and revised by the International Autoimmune Hepatitis Group. The diagnosis of autoimmune disease is based on the presence of high level of aspartate aminotransferase and alanine aminotransferase and IgG levels, positivity for circulating autoantibodies, and a picture of interface hepatitis on histology. However, in some patients cholestasis is present. In these cases, extra-hepatic obstruction, cholestatic forms of viral hepatitis, drug-induced disease, primary biliary cirrhosis, primary sclerosing cholangitis, and overlap syndromes must be taken into consideration.

Conclusion

Autoimmune hepatitis is not transmissible. It cannot spread from one person or organism to another, typically by direct contact. It is an autoimmune disease i.e. they occur when the immune cells in the body produce antibodies (called autoantibodies) against its own cells and attack them. It is generally present with no symptoms and can lead to chronic hepatitis if it is left untreated. Chronic hepatitis is the state of cirrhosis which may progress to liver failure. Autoimmune hepatitis also observed in patients who have systemic autoimmune conditions such as celiac disease, vasculitis, and autoimmune thyroiditis. The pathogenesis of autoimmune hepatitis is not fully understood, although there is increasing evidence that genetic susceptibility, molecular mimicry, and impaired immunoregulatory networks contribute to the initiation and perpetuation of the autoimmune attack.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: July 9, 2018

This article does not provide medical advice. See disclaimer

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