Autoimmune Hepatitis
A liver inflammation where the immune system attacks the liver. Treated with steroids and immune-suppressing medications. Most patients respond well and avoid cirrhosis.
Category
Chronic
Red flags
2
This article is educational and does not replace your doctor's advice. Seek urgent care for any red-flag symptoms.
What is it?
In autoimmune hepatitis (AIH), the body's immune system mistakenly recognizes liver cells as foreign and attacks them. This causes ongoing inflammation that can lead to scarring (cirrhosis) if not treated. Two types: Type 1 (most common, all ages, with anti-smooth muscle antibodies) and Type 2 (less common, mainly children/young adults).
How common is it?
Rare — about 10-20 per 100,000. More common in women (4:1). Often coexists with other autoimmune diseases (thyroid, celiac, IBD).
Why does it happen?
Genetic predisposition + an environmental trigger (often unidentified). May follow viral infection, certain medications, or pregnancy.
Symptoms
- Often silent — found on routine blood tests
- Fatigue
- Jaundice
- Joint pain
- Itching
- Nausea, loss of appetite
Red flags — seek urgent medical care
Severe jaundice with confusion
Possible acute liver failure — emergency.
New cirrhosis complications
Urgent specialist care.
How is it diagnosed?
Blood tests: very elevated ALT/AST, elevated IgG, autoantibodies (ANA, anti-SMA, anti-LKM). Liver biopsy is usually needed to confirm. Other liver diseases (viral, drug-induced, NASH) must be excluded.
Outlook — what to expect
80% achieve remission with treatment. Lifelong therapy is usually needed. With good control, life expectancy is normal. Untreated AIH leads to cirrhosis and liver failure.
Treatment
Habits & Lifestyle
Adherence to medications is critical.
- Take medications EXACTLY as prescribed — even when feeling well.
- Avoid alcohol entirely.
- Get vaccinated against hepatitis A and B.
- Bone density check — long-term steroids cause osteoporosis.
- Pregnancy planning is important — adjustment of meds may be needed.
Diet
Standard healthy diet.
- Mediterranean pattern.
- Adequate calcium and vitamin D for bone health on steroids.
Medications
Two-drug induction then maintenance.
- Prednisone (high dose initially) + azathioprine (long-term steroid-sparing).
- Budesonide is an alternative steroid with fewer side effects in non-cirrhotic patients.
- Mycophenolate or tacrolimus for patients who don't tolerate azathioprine.
- Treatment is usually lifelong; trials of withdrawal possible after years of remission.
Procedures & Surgery
Procedures address complications.
- Liver biopsy at diagnosis (and sometimes repeat).
- Liver transplant for end-stage disease.
Questions to ask your doctor
Save this list or print it before your appointment — doctors appreciate prepared patients.
- Will I need lifelong medication?
- Could I be tapered off steroids?
- Should I be screened for other autoimmune diseases?
Medically reviewed by: SGA Hepatology Panel · Last reviewed 24/04/2026