What's autoimmune hepatitis and how does it differ from other forms?

Hepatitis has many causes

How rare is autoimmune hepatitis?

It is thought that around 10,000 people in the UK are living with autoimmune hepatitis¹. This makes up a small percentage of people living with a type of hepatitis - where your liver becomes inflamed (swollen) risking further liver damage and serious complications.

The type of hepatitis you have is related to what caused this liver inflammation. These are all treated differently, and fall into the following categories:

What is autoimmune hepatitis?

Autoimmune hepatitis is an autoimmune disease; this means that your body's immune system makes antibodies to attack your liver cells, mistaking them for foreign cells that could cause you harm. Experts have identified two types of autoimmune hepatitis: type 1 and type 2. Your body makes different antibodies in each type.

This internal attack can cause inflammation and liver damage. Experts are not sure why this happens in some people and not in others, but there are a few possible triggers:

Is autoimmune hepatitis hereditary?

You could have a genetic predisposition to autoimmune hepatitis. This means that certain genes passed on to you from your family could make your immune system more likely to turn on its own cells. This is why 30-50% of people with autoimmune hepatitis also have other autoimmune conditions, such as type 1 diabetes and thyroid disease¹.

Can certain substances cause autoimmune hepatitis?

Just like toxic hepatitis, certain harmful substances such as medicines and chemicals can cause your liver to become inflamed. Whereas in toxic hepatitis it's these toxins themselves that cause the damage, in autoimmune hepatitis it's your body's defence response that does the harm.

Can stress cause autoimmune hepatitis?

The link between stress and autoimmune disease has been implicated in many studies. One study found a significantly higher incidence of autoimmune diseases, such as rheumatoid arthritis and lupus, among those previously diagnosed with stress-related illnesses².

Another that focused specifically on people living with autoimmune hepatitis found that those who were stressed were more likely to relapse (have their symptoms return after treatment)³.

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What you need to know about hepatitis

The World Health Organization's global hepatitis strategy aims to reduce new hepatitis infections by 90% and deaths by 65% by 2030. The UK has made great strides towards this target by increasing vaccinations and introducing new and improved treatments. Testing has also been increased and the NHS has now introduced a simple, at home self-test for hepatitis C. Find out here what hepatitis does to the body and what causes it.

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Hepatitis C

Hepatitis C is a blood-borne virus that infects the cells of the liver. Most cases occur in people who share needles or injecting equipment contaminated with traces of blood to inject 'street drugs'. Some people clear the infection naturally. Some people with persistent infection remain free of symptoms, although others have symptoms. Persistent hepatitis C infections can lead to 'scarring' of the liver (cirrhosis) and may lead to liver cancer. Treatment can clear the infection in around 9 out of 10 cases.

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How do you test for autoimmune hepatitis?

Symptoms of autoimmune hepatitis can range from non-existent or mild (for example, feeling tired, sick, or achy) to severe (for example, yellow skin, dark urine, or abnormal blood vessels).

In fact, many people have no symptoms for quite some time, which means that most will only be diagnosed when they are tested for an unrelated condition.

When your symptoms suggest you may have hepatitis, your doctor can run the following tests:

• Blood tests, including liver function tests and other blood tests that measure antibodies found in autoimmune diseases.

• An ultrasound scan of the liver.

• A small sample of the liver can be taken and studied under a microscope (a liver biopsy).

Can autoimmune hepatitis be cured?

While some types of hepatitis are acute (short-term), autoimmune hepatitis is always chronic (lasts longer than six months) and is often with you for life. As the inflammation gradually damages your liver cells, there is a risk of serious and even life-threatening complications.

These include:

• Liver scarring (cirrhosis).

• Liver failure.

• Liver cancer.

The good news is that treatment makes a huge difference. This comes in the form of various medicines that improve your symptoms and reduce your chances of developing these complications.

How long can you live with autoimmune hepatitis?

Within 10 years of developing autoimmune hepatitis, it is thought that your chances of dying are twice that of someone without autoimmune hepatitis⁴. However, medicines are dramatically changing the course of the disease and are providing hope:

• Without treatment - roughly 40-50% of people with severe autoimmune hepatitis die within six months to five years.

• With treatment - around 84-94% of people live beyond the 10-year mark⁵ and have a normal life expectancy.

Can you live a normal life with autoimmune hepatitis?

It's one thing looking at life expectancy, but what about the quality of your life? Thanks to treatment, most people with autoimmune hepatitis feel well most of the time. It's common to be on treatment on-and-off throughout your life, as autoimmune hepatitis symptoms often return.

The general advice is to follow a healthy diet, as this may reduce the risk of complications.

Can you drink alcohol with autoimmune hepatitis?

As all alcoholic beverages can cause further harm to your liver, ideally you should avoid drinking. Failing that, you should only drink in very small amounts. Alcohol causes inflammation and can be a sole cause of (alcoholic) hepatitis. If your liver is already inflamed, drinking can speed up liver damage that leads to serious illness.

Further reading

1. British Liver Trust "Autoimmune hepatitis".

2. Song, Fang and Tomasson "Association of stress-related disorders with subsequent autoimmune disease".

3. Srivastava and Boyer "Psychological stress is associated with relapse in type 1 autoimmune hepatitis".

4. Sharma, Verna, Söderling, Roelstraete, Hagström and Ludvigsson "Increased mortality risk in autoimmune hepatitis".

5. Cleveland Clinic "Autoimmune hepatitis".