Diagnostic difficulties, therapeutic strategies, and performance of scoring systems in patients with autoimmune hepatitis and concurrent hepatitis B/C

Cumali Efe, Staffan Wahlin, Ersan Ozaslan, Tugrul Purnak, Luigi Muratori, Chiara Quarneti, Gonca Tatar, Halis Simsek, Paolo Muratori, Thomas D. Schiano

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Background. The diagnosis of autoimmune hepatitis (AIH) is already difficult, and that of AIH with chronic viral hepatitis including hepatitis B (HBV) or hepatitis C (HCV) is even more challenging. To date, only a few case-based studies have described this association. Aim. The aim was to retrospectively assess diagnostic difficulties, therapeutic approaches, and performance of the scoring systems in AIH patients with concurrent HBV and HCV. Methods. A total of 25 patients from United States, Sweden, Italy, and Turkey were retrospectively evaluated. Both revised and simplified criteria suggested by the International Autoimmune Hepatitis Group were applied for each patient. All study data were obtained from medical records. Results. Of the 25 patients, 20 (80%) had concomitant HCV and 5 (20%) had HBV. Based on the revised scoring system and simplified criteria, 18 (72%) and 12 (48%) patients were diagnosed as "probable" AIH. None of the patients were diagnosed as "definite" AIH according to both scoring systems. Patients with HCV initially were treated with immunosuppressive agents, and antiviral therapy was commenced when biochemical remission occurred. AIH patients with HBV were first treated with antiviral and thereafter, immunosuppressive therapy was started. Conclusions. This large case series describes concurrent AIH and chronic viral hepatitis. The revised scoring system for AIH had a better performance than the simplified scoring system. However, neither scoring system is optimal for diagnosing AIH alone. In these patients, a definitive diagnosis of AIH should be based on a combination of serological profiles, histological findings, scoring systems, treatment response, and outcomes.

Original languageEnglish
Pages (from-to)504-508
Number of pages5
JournalScandinavian Journal of Gastroenterology
Volume48
Issue number4
DOIs
StatePublished - Apr 2013

Keywords

  • Auto-antibody
  • Autoimmune hepatitis
  • Hepatitis B
  • Hepatitis C
  • Overlap syndrome
  • Revised criteria
  • Simplified criteria

Fingerprint

Dive into the research topics of 'Diagnostic difficulties, therapeutic strategies, and performance of scoring systems in patients with autoimmune hepatitis and concurrent hepatitis B/C'. Together they form a unique fingerprint.

Cite this