The prognosis for autoimmune hepatitis becomes worse when it is associated with liver cirrhosis and the presence of soluble liver antigen and the liver pancreas antigen (SLA/LP) antibodies. Recent studies done on patients with autoimmune hepatitis show that the first diagnosis of cirrhosis of the liver and the presence of the above mentioned antibodies increase the risk of poor short-term and poor long-term outcomes. The researchers also found that patients diagnosed earlier (in childhood) not only had a higher risk of relapse, but their life expectancy was reduced and they were prime candidates for a liver transplant.
A chronic inflammatory disease, autoimmune hepatitis results in damage to the liver as a result of the body’s immune system attacking healthy liver cells.
According to lead author Dr. Arndt Vogel from Hannover Medical School in Germany, early diagnosis and timely medical therapy can help patients with autoimmune hepatitis have a good prognosis. But if the disease is not detected early, it can end up with severe symptoms and complications. Dr. Vogel explains that their study examines the genetic and clinical features of remission, relapse and liver transplant-free survival in patients with autoimmune hepatitis.
For the study, the team analyzed 264 patients with autoimmune hepatitis who were treated at Hannover Medical School between 2000 and 2014, and 399 patients without autoimmune hepatitis. The researchers did not take into account subjects with viral hepatitis, haemochromatosis, Wilson’s disease and alcoholic and non-alcoholic liver disease.
At the end of the study, the researchers found that in the patients with SLA/LP antibodies the overall survival and liver transplant-free survival was significantly reduced. And the patients with a childhood diagnosis of autoimmune hepatitis had an increased risk of relapse, higher risk of needing a liver transplant and a reduced life expectancy. And in the 25 percent of patients with whom liver cirrhosis was apparent at first diagnosis, the risk of survival was poor and the need for liver transplantation was high.
Besides cirrhosis of the liver, there are other factors that could influence and increase the risk of autoimmune hepatitis. They include:
Being female – Although autoimmune hepatitis can occur in both men and women the incidence of occurrence is higher in women.
Age – While type-1 autoimmune hepatitis is not associated with age and can occur any time, type-2 autoimmune hepatitis usually affects young females.
Infections – A bacterial or viral infection may pave the way for autoimmune hepatitis.
Medications – Certain medicines like the antibiotic, minocycline, and the cholesterol medication, Lipitor, have been known to be risk factors for autoimmune hepatitis.
Heredity – The predisposition for autoimmune hepatitis to run in families is backed by historical evidence.
Autoimmune disease – People who already have an autoimmune disease may be more likely to develop autoimmune hepatitis.
Depending on the presence of antibodies in the blood, there are three types of autoimmune hepatitis:
Of the three, the most common type in North America is type-1 autoimmune hepatitis. As mentioned before, it can occur at any age; however, it most often starts at a young age, during and immediately after the teenage years. Females account for about 70 percent of type-1 autoimmune hepatitis patients. Most people with type-1 autoimmune hepatitis commonly have other autoimmune disorders.
Type-2 autoimmune hepatitis is not as common as its type-1 cousin and occurs more often in children than adults. Like type-1 patients, type-2 patients may also have other autoimmune disorders.
For both type-1 and type-2 autoimmune hepatitis, the aim of the treatment is to deter the body’s immune system from attacking the liver, and in the process slow down the progression of the disease.
The common medications and treatments used to get your immune system back on track are:
As one can expect, living with a chronic liver disease is not easy. The best way is to find methods to cope with the symptoms and overcome the difficulties that the disease can bring about. To manage the disease successfully it is important to:
From the study mentioned at the start of this article, it’s clear that autoimmune hepatitis patients diagnosed in childhood, those that present with cirrhosis at the time of initial diagnosis or who have SLA/LP antibodies, have poor clinical outcomes. It’s important that these patients are kept under close surveillance and given all the support and help they can get to cope with the disease. For more suggestion on how to help these patients visit the American Liver Foundation’s website at http://www.liverfoundation.org/ or call 800-465-4837.
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