Blog
Autoimmune hepatitis
Covenant Metabolic Specialists Health Library
Covenant Metabolic Specialists
Physician Reviewed
Dec 3, 2025
Autoimmune hepatitis is a chronic condition in which the body’s immune system mistakenly attacks the liver, causing inflammation and long-term damage. If left untreated, it can progress to cirrhosis or liver failure. With early diagnosis and proper treatment, most patients can control the disease and prevent serious complications.
What is Autoimmune Hepatitis?
Autoimmune hepatitis (AIH) is a type of liver inflammation caused by an abnormal immune response. Instead of protecting the body from infection, the immune system targets liver cells, causing progressive injury. AIH can occur at any age and affects all genders, but it’s more common in women. The condition may come on suddenly or develop gradually, and it often goes undetected until liver damage is advanced.
Symptoms
Symptoms of autoimmune hepatitis can vary widely, ranging from mild to severe. Some people are asymptomatic in early stages.
Common symptoms include:
Fatigue
Abdominal discomfort (especially upper right quadrant)
Joint pain (arthralgia)
Nausea and decreased appetite
Dark urine and pale stools
Yellowing of skin and eyes (jaundice)
Skin rashes or acne-like eruptions
Irregular menstrual cycles
Spider angiomas (clustered blood vessels near the surface of the skin)
Enlarged liver (hepatomegaly)
In more advanced cases:
Fluid buildup in the abdomen (ascites)
Mental confusion or drowsiness (hepatic encephalopathy)
Signs of cirrhosis or liver failure
Causes
The exact cause of autoimmune hepatitis is unknown, but it's believed to be triggered by a combination of genetic predisposition and environmental triggers.
Possible triggers may include:
Certain medications (e.g., minocycline, nitrofurantoin)
Viral infections (e.g., hepatitis A, B, C, or Epstein-Barr)
Hormonal changes
Exposure to toxins or chemicals
Other autoimmune diseases (e.g., type 1 diabetes, celiac disease, thyroiditis)
Risk Factors
You may be at increased risk for autoimmune hepatitis if you:
Are female (75% of AIH cases occur in women)
Are between the ages of 15 and 40 (type 1) or over 60 (type 2)
Have a family history of autoimmune conditions
Live with another autoimmune disorder (thyroid disease, lupus, rheumatoid arthritis, etc.)
Carry HLA-DR3 or DR4 genes, which are associated with autoimmune liver disease
Diagnosis
Diagnosis involves ruling out other causes of hepatitis (such as viral or alcoholic liver disease) and identifying autoimmune markers.
Diagnostic workup typically includes:
Liver function tests (LFTs): Elevated ALT, AST, bilirubin
Immunoglobulin G (IgG): Usually elevated
Autoantibody screening:
ANA (antinuclear antibodies)
ASMA (anti-smooth muscle antibodies)
LKM-1 (liver-kidney microsomal)
Liver biopsy: Confirms inflammation and helps assess damage
Imaging (e.g., ultrasound): Rules out other liver pathology
Treatments
Autoimmune hepatitis requires long-term medical management to suppress the immune system and reduce liver inflammation.
First-line treatments:
Corticosteroids (prednisone or budesonide): Reduce immune activity
Azathioprine: An immunosuppressant often used with lower-dose steroids
Alternative immunosuppressants for resistant cases: mycophenolate mofetil, cyclosporine, or tacrolimus
Supportive care includes:
Monitoring liver enzymes and medication side effects
Calcium + Vitamin D to protect bones (steroids increase osteoporosis risk)
Managing comorbid autoimmune conditions
Most people respond well within weeks to months of treatment. Lifelong therapy is often required to maintain remission.
Prevention
Autoimmune hepatitis is not preventable, but you can protect your liver by:
Avoiding alcohol and hepatotoxic medications
Getting vaccinated against hepatitis A and B
Monitoring for flare-ups if you’re already diagnosed
Managing related autoimmune diseases
Staying consistent with prescribed immunosuppressants and follow-up labs
Our Take
We often see autoimmune hepatitis get mistaken for "mild liver enzyme elevations" or stress-related fatigue. But when the immune system turns against the liver, time matters. At Covenant, we don’t wait—we test, confirm, and treat early to prevent irreversible liver damage. Our integrative approach monitors not just the liver, but the patient behind the labs.
