Autoimmune hepatitis is a relatively rare disease but the number of cases has been increasing in recent years. Thus, 25 years ago its prevalence was 9.95 cases per 100,000 inhabitants and currently it is 27.91 cases per 100,000.
Autoimmune hepatitis occurs because the person’s own defenses attack the liver cells, causing inflammation and destruction. The cause is unknown, although it has been associated with various triggers, such as hepatitis A virus or vaccines (flu, Covid, etc.). This seems logical since vaccines increase defenses and these can attack the liver when there is a genetic predisposition to do so. Also some antibiotics (minocycline, nitrofurantoin) can induce the onset of the disease.
Incidence of acute hepatitis
Autoimmune hepatitis is a potentially very aggressive disease and needs to be diagnosed and treated as soon as possible. It can appear at any age and affects more women than men, in a 4:1 ratio. There are two forms of presentation of autoimmune hepatitis: acute hepatitis and chronic disease.
Acute hepatitis represents 25% of cases and begins with fatigue, a very significant increase in transaminases (levels can even be higher than 1,000 IU/L) and jaundice (yellowing of the skin). For the diagnosis of acute autoimmune hepatitis, it is very important to rule out other more common causes of acute hepatitis, such as infection by hepatitis viruses A, B, C and E, Cytomegalovirus, Epstein-Barr virus, Wilson’s disease (accumulation of copper in the liver) or drugs (antipsychotics, anabolic steroids, etc.).
Chronic liver disease presents with a moderate increase in transaminases (values generally less than 500 IU/L), which present oscillations in their levels over time and are sometimes even within the limits of normality. As in acute disease, other causes of liver disease must be ruled out.
Autoimmune hepatitis diagnosis
Autoimmune hepatitis is diagnosed by the presence of autoantibodies in the patient’s blood (anti-smooth muscle, antinuclear, anti-LKM, etc.) and there is also usually an increase in IgG immunoglobulin. However, in around 5% of cases of autoimmune hepatitis, no autoantibodies or increased IgG levels are detected and the disease is very difficult to diagnose.
In this sense, Dr. Carreño and his team at the Foundation take into account all these disease onset profiles to diagnose autoimmune hepatitis. They also always recommend doing a liver biopsy to confirm the diagnosis.
