Autoimmune hepatitis and overlap syndromes

Autoimmune hepatitis (AIH) is a progressive necro-inflammatory liver disease associated with significant morbidity and mortality. It affects mainly females and has a varied clinical presentation from minor symptomatology to acute liver failure. The diagnosis should be considered in anyone with abnormal liver function tests. Diagnostic features include biochemical evidence of transaminitis, elevated immunoglobulin G and positive autoantibodies. Liver biopsy may show interface hepatitis with portal-based plasma cell infiltrates. AIH may present with features of other autoimmune liver conditions or overlap syndromes. AIH responds promptly to immunosuppression therapy including corticosteroids (prednis(ol)one or budesonide) with azathioprine. Joint care between primary healthcare and hepatology services is required to monitor treatment efficacy, adverse effects and signs of progressive cirrhosis and liver failure.