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Autoimmune hepatitis

Last reviewed: 3 Nov 2023
Last updated: 18 Aug 2021



History and exam

Key diagnostic factors

  • fatigue/malaise
  • anorexia
  • abdominal discomfort
  • hepatomegaly
  • jaundice
  • encephalopathy
More key diagnostic factors

Other diagnostic factors

  • pruritus
  • arthralgia
  • nausea
  • fever
  • spider angiomata
  • gastrointestinal bleeding
  • splenomegaly
  • ascites
Other diagnostic factors

Risk factors

  • female sex
  • genetic predisposition
  • immune dysregulation
  • measles virus
  • cytomegalovirus
  • Epstein-Barr virus
  • hepatitis viruses A, C, and D
  • certain drugs
More risk factors

Diagnostic investigations

1st investigations to order

  • aspartate transaminase
  • alanine transaminase
  • bilirubin
  • gamma glutamyl transferase (gamma-GT)
  • alkaline phosphatase
  • serum globulin
  • serum albumin
  • prothrombin time
More 1st investigations to order

Investigations to consider

  • antinuclear antibodies (ANAs)
  • smooth muscle antibodies (SMAs)
  • anti-soluble liver antigens or liver/pancreas (anti-SLA/LP)
  • perinuclear antineutrophil cytoplasmic antibodies (pANCA)
  • antibodies against single-stranded DNA (anti-ssDNA)
  • antibodies against double-stranded DNA (anti-dsDNA)
  • antibodies to liver/kidney microsome type 1 antigen (anti-KLM-1)
  • antibodies to liver/kidney microsome type 3 antigen (anti-LKM-3)
  • antibodies to liver cytosol 1 antigen (anti-LC1)
  • antimitochondrial antibodies (AMAs)
  • antibodies against asialoglycoprotein receptor (anti-ASGP-R)
  • IgM antibodies to hepatitis A virus (IgM anti-HAV)
  • antibodies to hepatitis B core antigen (anti-HBc)
  • hepatitis C antibodies and viral RNA
  • ceruloplasmin
  • alpha-1 antitrypsin
  • serum iron and total iron binding capacity
  • thiopurine methyltransferase (TPMT) activity
  • abdominal ultrasound
  • liver biopsy
More investigations to consider

Treatment algorithm


acute severe disease


active disease

inactive disease or minimally active disease with comorbidities

AIH-primary biliary cirrhosis overlap syndrome


inadequate response to initial therapy or single relapse: without hepatic decompensation

multiple previous relapses: without hepatic decompensation

decompensated liver disease



George Y. Wu, MD, PhD
George Y. Wu

Professor of Medicine

University of Connecticut School of Medicine




GYW presents lectures on autoimmune hepatitis nationally and internationally. He has acted as an expert witness for legal firms, is comprehensive editor in chief of the Journal of Clinical and Translational Hepatology, associate editor of Medjaden, and is a book series editor for Nature-Springer.

Roopjeet K. Bath, MBBS
Roopjeet K. Bath

Assistant Professor of Medicine

University of Connecticut School of Medicine




RKB declares that she has no competing interests.


Dr George Y. Wu and Dr Roopjeet K. Bath would like to gratefully acknowledge Dr Micheal Tadros, Dr Lucija Virovic Jukic, Dr Marcy L. Coash, and Dr Deepika Devuni, previous contributors to this topic. Dr Wu would also like to acknowledge the assistance of Dr Nathan Selky in the 2011 update.


MT, LVJ, MLC, and DD declare that they have no competing interests.

Peer reviewers

Kittichai Promrat, MD

Assistant Professor

Division of Gastroenterology

Department of Medicine

Brown University



KP declares that he has no competing interests.

  • Differentials

    • Primary biliary cirrhosis
    • Primary sclerosing cholangitis
    • Chronic hepatitis B
    More Differentials
  • Guidelines

    • Diagnosis and management of autoimmune hepatitis in adults and children
    • EASL clinical practice guidelines: autoimmune hepatitis
    More Guidelines
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