Autoimmune hepatitis natural history, complications and prognosis

Autoimmune hepatitis has a bimodal age distribution, with the first peak of incidence at age 10-20 years and a second at age 45-70 years. Patients presents initially with no symptom but can progress to acute liver failure If not treated, patients can develop complications like cirrhosis, portal hypertension, esophageal varices, metabolic bone disease, hyperlipidaemia, hypovitaminosis, cholestasis. Prognosis is generally excellent, and the 10-year survival rate of patients with autoimmune hepatitis treated with immunosuppressive therapy is approximately 80%. The presence of young age at presentation, AIH-2, coagulopathy, severe histologic activity is associated with a poor prognosis among patients with autoimmune hepatitis.

• The symptoms of autoimmune hepatitis usually has a bimodal age distribution, with a first peak of incidence at age 10-20 years and a second at age 45-70 years of life, and starts with asymptomatic progresses to acute liver failure.^[1]
• If left untreated, patients with autoimmune hepatitis may progress to develop cirrhosis, and portal hypertension.

Common complications of Autoimmune hepatitis include:^[2][3]

• Cirrhosis and complications of cirrhosis:
  • Ascites
  • Coagulopathy
  • Liver failure
  • Hepatocellular carcinoma
  • Hepatic encephalopathy
• Portal hypertension
• Esophageal varices
• Metabolic bone disease
• Hyperlipidaemia
• Hypovitaminosis
• Cholestasis

• Prognosis is generally excellent, and the 10-year survival rate of patients with autoimmune hepatitis treated with immunosuppressive therapy is approximately 80%.^[4][5]
• Prognosis is poor without treatment, 50% of patients with severe autoimmune hepatitis will die in a 5 years.
• The presence of young age at presentation, AIH-2, coagulopathy, severe histologic activity is associated with a poor prognosis among patients with autoimmune hepatitis.

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