What to know about autoimmune hepatitis treatments and their side effects

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A person’s immune system protects the body from invading bacteria, viruses, or other organisms. The immune system helps fight infection by using cells called antibodies and lymphocytes.

However, the immune system of a person with AIH attacks healthy liver cells, causing inflammation and damage.

There are two types of AIH that a person can have: Type 1 and type 2. Type 1 AIH is more common, and is usually found in adults. Type 2 AIH is less common, more severe, and generally found in children.

Some people with AIH do not have any symptoms. However, possible symptoms of AIH can include:

• fatigue
• joint pain
• nausea
• diarrhea
• poor appetite
• loss of brain function
• fluid in the abdomen
• swollen legs
• easy bruising or bleeding
• enlarged spleen
• gallstones
• vomiting
• no menstrual period in females
• pain in the upper part of the abdomen
• jaundice, which causes yellowing of the skin and eyes
• dark-colored urine
• light-colored stool
• skin conditions such as rash, psoriasis, acne, or vitiligo

There is no cure for AIH. However, treatments for AIH can help relieve symptoms. They may also prevent or reverse liver damage.

The National Institute for Diabetes and Digestive and Kidney Diseases (NIDDK) notes that early treatment for AIH can lower the chances of a person developing other complications.

Some people who have a mild case of AIH, or who have no symptoms, may not require treatment. Other people will require lifelong treatment for AIH.

Remission

After receiving treatment for AIH, some people may go into remission. Remission means that a person:

• no longer has AIH symptoms
• has a liver with improved function
• is no longer experiencing liver damage

Once a person is in remission from AIH, a doctor may reduce their medications or stop treating them.

However, being in remission does not mean that a person is cured of AIH. Without certain treatments, the risk of AIH returning is more than 80%. This is why it is important that a doctor carefully monitors a person with AIH.

Outlook

The outlook for a person with AIH can vary based on:

• when they were diagnosed
• if they relapse
• if they develop any complications
• how their AIH responds to treatment
• if they require a liver transplant

A study from 2015 found that people diagnosed with AIH in childhood were more likely:

• to have a relapse
• to need a liver transplant
• to have a shorter life expectancy

Researchers also found that people who developed liver scarring as a result of AIH had lower life expectancy.

Doctors usually treat AIH using medication. However, if a person has liver failure due to AIH, they may need a transplant.

Medication

When treating AIH, a doctor will typically prescribe immunosuppressants. Immunosuppressants are a type of medication that suppresses a person’s immune system.

When starting treatment for AIH, a doctor may use corticosteroids, which reduce inflammation as well as being immunosuppressants.

Types of corticosteroid doctors may use to treat AIH include:

• prednisone
• prednisolone
• budesonide

Doctors may prescribe corticosteroids with or without another immunosuppressant called azathioprine.

If a person cannot tolerate azathioprine, alternative medications they can take include:

• mycophenolate mofetil
• cyclosporine
• sirolimus
• tacrolimus

Liver transplant

If a person’s AIH progresses and causes liver failure or severe liver scarring, they may require a liver transplant. The Genetic and Rare Diseases Information Center (GARD) states that around 10⁠–20% of people with AIH will need a liver transplant.

A liver transplant involves surgeons removing a person’s diseased liver and replacing it with a healthy one. Liver donations can come from a deceased donor or from a living donor.

A person receiving a transplant from a living donor receives part of the donor’s liver, which will eventually grow to full size.

The NIDDK lists the following survival rates for a person who receives a liver transplant from a deceased donor:

• 86% at 1 year
• 78% at 3 years
• 72% at 5 years
• 53% at 20 years

Stem cells

There is currently limited information on the effect of stem cells on AIH.

In 2020, researchers looked into the effect of treating mice with AIH using stem cells from human milk teeth. Researchers found that the stem cells reduced inflammatory liver damage in the mice.

However, further studies are required to see if this effect could be reproduced using stem cells in humans.

Treatment specific side effects may include:

Prednisone

Side effects of prednisone include:

• bone loss
• high blood sugar
• increased appetite
• insomnia
• changes in mood
• muscle pain
• depression
• anxiety

Prednisolone

Prednisolone side effects include:

• headaches
• changes in mood
• acne
• slow healing of cuts and bruises
• fatigue
• dizziness
• weight gain
• changes in appetite
• swelling

Budesonide

Side effects of budesonide include:

• headache
• nausea
• respiratory infection
• hypercorticism

Azathioprine

Azathioprine side effects include:

• nausea
• vomiting
• increased risk of lymphoma, a form of blood cancer

Mycophenolate mofetil

Mycophenolate mofetil can cause:

• abdominal pain
• nausea
• vomiting
• diarrhea
• constipation
• anorexia
• altered kidney function
• birth defects in pregnant females

Cyclosporine, sirolimus, and tacrolimus

Cyclosporine, sirolimus, and tacrolimus can cause:

• nausea
• diarrhea
• constipation
• abdominal pain
• high blood pressure
• increased cholesterol
• joint pain
• diabetes
• gingivitis

Liver transplant

Following a liver transplant, a person may experience organ rejection. Organ rejection occurs when a person’s immune system does not recognize the new liver as part of the body. The person’s immune system then attacks the new liver, causing damage.

Signs of organ rejection include:

• fatigue
• pain or tenderness in the abdomen
• fever
• jaundice
• dark-colored urine
• light-colored stool

Having AIH can mean a person is more likely to have other conditions. Early diagnosis and treatment can reduce a person’s chances of developing complications from AIH.

Complications from AIH include:

• cirrhosis, which is scarring of the liver
• liver failure
• acute liver failure, where a person’s liver fails suddenly
• liver cancer

A person with AIH can live a relatively normal life. The cause of AIH is not fully clear, although possible triggers include:

• genetics
• certain medications
• infection

Researchers have found no link between diet and AIH. Therefore, a person with AIH does not need to restrict what they eat.

However, a person with AIH should aim to eat a healthy diet, and reduce alcohol intake. Obesity and alcohol can affect liver function, which can lead to further liver damage.

A person with AIH should be careful to monitor their symptoms and check in regularly with their doctor.

The American Liver Foundation suggests that a person with AIH ask their doctor the following questions:

• Are their symptoms due to AIH?
• What type of AIH do they have?
• Is there liver damage?
• Will they need a transplant?
• Do they have any additional autoimmune diseases?
• What treatment will work best for them?
• Do they need to undergo any testing?
• What treatment can they have if medication does not work?
• Will the doctor do other testing to check for liver cancer, etc.?
• How will the doctor monitor their AIH?

AIH is a condition caused by a person’s immune system attacking their liver.

There are different treatments for AIH. Each treatment can cause certain side effects. A person should speak to their doctor to determine what treatment is best for their AIH.

People with AIH can live a relatively normal life. However, a person with AIH should avoid substances that may harm the liver.