Autoimmune Hepatitis (AIH)

Medically Reviewed by Sabrina Felson, MD on June 09, 2024
3 min read

Autoimmune hepatitis (AIH) is when your immune system -- your body's main defense against germs -- attacks your liver cells. Your doctor may also call it autoimmune chronic hepatitis. It’s a chronic liver disease that is treatable but can not be cured.

Treatment can help you manage your symptoms and prevent damage to your liver. It will require lifelong monitoring.

You might not notice any symptoms. If you do, they can range from mild or severe.

Symptoms like fever, belly pain, and yellowing of your skin and eyes may come on suddenly. More often, the signs show up over weeks or months.

The most common symptom is feeling tired. You may also have:

  • Joint or muscle pain 
  • Lack of appetite and weight loss
  • Nauseavomiting, or belly pain
  • Acne and skin rashes
  • Pee that is dark or very yellow
  • Bowel movements that are light-colored
  • Diarrhea
  • Lack of menstrual period
  • Jaundice (yellowing of your skin or eyes)
  • Enlarged spleen
  • Gallstones
  • Brain problems (hepatic encephalopathy)

There are two major types of autoimmune hepatitis. Both are rare.

  • Type 1 is the more common kind. You're more likely to get it if you're a woman ages 15 to 40, although people of any age or gender can get it.
  • Type 2 usually happens to girls ages 2 to 14.

If you have AIH, you probably also have another autoimmune disease, such as ulcerative colitis, rheumatoid arthritislupus, or Sjogren's syndrome.

Doctors aren't sure exactly what causes your immune system to turn against your liver. Your genes may have something to do with it, since AIH can run in families.

But genes aren't the whole story. Something you come into contact with may trigger your genes to set autoimmune hepatitis in motion. This could include:

Your doctor will ask about your symptoms. They'll also want to know what medications you take and how much alcohol you drink. Both can damage your liver.

They'll order blood tests that can rule out other conditions like viral hepatitis. Blood tests can also spot things called autoantibodies, which might be signs of an autoimmune disease. Different patterns of the autoantibodies are the main distinction between the two types of AH. The symptoms are common to both. 

Other blood tests can tell whether your liver is damaged.

Your doctor will do a liver biopsy. They’ll take out a small piece of your liver and look at the cells under the microscope.

Sometimes, AIH can cause liver damage called cirrhosis. This can lead to problems including:

  • Itching
  • Bruising
  • Bleeding that won't stop
  • Swollen stomach or ankles
  • Spidery blood vessels
  • Confusion
  • Liver failure 
  • Hepatocellular carcinoma

If you don't have any symptoms of AIH, your doctor may decide not to treat you right away. Instead, you'll have blood tests and liver biopsies now and then to make sure your liver is healthy.

Treatment usually starts once you have symptoms or your doctor notices that your lab test results are getting worse. At first, they’ll probably prescribe prednisone, a steroid that eases inflammation. They might start you on a high dose and then lower it and add azathioprine (Imuran) or 6-mercaptopurine (Purinethol), to decrease inflammation and halt the progression of the disease. A side effect of all of these medications is a weakened immune system.

These drugs can have side effects. Steroids can make your bones weak, cause you to gain weight, and give you eye problems. Azathioprine and 6-mercaptopurine can lower your number of white blood cells and raise your chances of getting cancer.

Sometimes, doctors use the steroid budesonide instead of prednisone. Your doctor may suggest other drugs that weaken your immune system instead of azathioprine, such as mycophenolate mofetil (CellCept).

After a period of treatment, sometimes several years, about 80% of people find that their condition is under control. You may be able to stop treatment while your doctor keeps an eye on your health. If your symptoms come back, you'll start treatment again.

Lifestyle changes can help keep you healthy. Eat a balanced diet and plenty of fruits and vegetables, and stay away from alcohol. Don't take any drugs or supplements without checking with your doctor.

If you get cirrhosis or liver failure, you may need a liver transplant. This is a surgery to take out your damaged liver and replace it with a healthy one from a donor.