Autoimmune hepatitis: Risk factors, pathophysiology, diagnosis and management

Author(s): Gudisa Bereda

Autoimmune hepatitis is characterized as an entity of chronic hepatitis that must be distinguished from chronic viral hepatitis, drug-induced and alcohol-induced hepatitis and idiopathic chronic hepatitis. The pathogenesis of autoimmune hepatitis is very complex and includes interactions between the tolerant liver, environmental triggers, and dysregulated immunological mechanisms. The immune response in autoimmune hepatitis is likely induced by the presentation of self-antigens to uncommitted naive CD4+ T Helper cells (TH0). Liver biopsy is considered the gold standard for assessing liver fibrosis in patients with autoimmune hepatitis. The objective of autoimmune hepatitis treatment is complete biochemical and histological remission, with minimum side effects of treatment, preventing fibrosis progression. Primary treatment involves steroid induction therapy, where the choice is based on histological severity and the fibrosis stage, followed by maintenance therapy with a steroid-sparings agent.