Autoimmune Hepatitis Diagnosis

Score for markers of hepatitis A, B and C viruses (i.e. positive/negative for IgM anti-HAV, HBsAg, IgM anti-HBc, anti-HCV and HCV-RNA). If a viral aetiology is suspected despite seronegativity for these markers, tests for other potentially hepatotropic viruses such as CMV and EBV may be relevant.

History of recent or current use of known or suspected hepatotoxic drugs.

Biliary changes refers to bile duct changes typical of PBC or PSC (i.e. granulomatous cholangitis, or severe concentric periductal fibrosis, with ductopenia, established in an adequate biopsy specimen) and/or a substantial periportal ductular reaction (so-called marginal bile duct proliferation with a cholangiolitis) with copper/copper-associated protein accumulation.

Any other prominent feature or combination of features suggestive of a different aetiology.

History of any other autoimmune disorder in patient or first-degree relatives.

Other defined autoantibodies are those for which there are published data relating to methodology of detection and relevance to AIH. These include pANCA, anti-LC1, anti-SLA, anti-ASGPR, anti-LP and anti-sulfatide

HLA DR3 and DR4 are mainly of relevance to North European caucasoid and Japanese populations. Answer YES to this question for other HLA Class II antigens for which there is published evidence of their association with AIH in other populations.

Assessment of response to therapy may be made at any time. Based on features observed at initial presentation. Complete Defined as: (a) Either or both of the following: marked improvement of symptoms and return of serum AST or ALT, bilirubin and immunoglobulin values completely to normal within 1 year and sustained for at least a further 6 months on maintenance therapy, or a liver biopsy specimen at some time during this period showing at most minimal activity. or (b) Either or both of the following: marked improvement of symptoms together with at least 50% improvement of all liver test results during the first month of treatment, with AST or ALT levels continuing to fall to less than twice the upper normal limit within 6 months during any reductions toward maintenance therapy, or a liver biopsy within 1 year showing only minimal activity. Relapse Defined as: (a)Either or both of the following: an increase in serum AST or ALT levels of greater than twice the upper normal limit or a liver biopsy showing active disease, with or without reappearance of symptoms, after 'complete' response as defined above. or (b)Reappearance of symptoms of sufficientseverity to require increased (or reintroduction of) immunosuppression, accompanied by any increase in serum AST or ALT levels, after 'complete' response as defined above.