Autoimmune hepatitis

Recent advances Dominique-Charles VALLA The field of autoimmune hepatitis has been quite active since the last update on the topic at the Day of Hepatology of Beaujon Hospital in 2002. A simplified diagnostic score, better knowledge of some unusual forms, more solid criteria for remission and relapse, better understanding of prognostic factors, and especially improved therapeutic options are now available. The purpose of this chapter is to discuss these advances. The overlapping forms of autoimmune hepatitis with other liver or biliary diseases will not be discussed here. Diagnosis The autoimmune hepatitis is characterized by three elements: (a) a particular lesion, interface hepatitis, (b) the absence of other causes of this lesion (viral hepatitis, drug-induced hepatitis, Wilson’s disease or alpha-1 antitrypsin deficiency); and (c) signs of autoimmunity (autoantibodies or other autoimmune diseases). Table 1. Simplified diagnostic criteria of autoimmune hepatitis Variable Cutoff Points ANA or SMA ≥ 1/40 1 ANA or SMA ≥ 1/80 and/or anti-LKM1 ≥ 1/40 2 and/or anti-SLA Positive IgG >ULN 1 >1.10 ULN 2 Liver biopsy Compatible 1 Typical 2 Absence of viral hepatitis Yes 2