Overview
In autoimmune hepatitis (AIH), the body's immune system mistakenly recognizes liver cells as foreign and attacks them. This causes ongoing inflammation that can lead to scarring (cirrhosis) if not treated. Two types: Type 1 (most common, all ages, with anti-smooth muscle antibodies) and Type 2 (less common, mainly children/young adults).
Symptoms
Often silent — found on routine blood tests
Fatigue
Jaundice
Joint pain
Itching
Nausea, loss of appetite
Self-Care Tips
Take medications EXACTLY as prescribed — even when feeling well.
Avoid alcohol entirely.
Get vaccinated against hepatitis A and B.
Bone density check — long-term steroids cause osteoporosis.
Pregnancy planning is important — adjustment of meds may be needed.
When to See a Doctor
Seek medical care promptly if you notice: Severe jaundice with confusion; New cirrhosis complications.
Why it happens
Genetic predisposition + an environmental trigger (often unidentified). May follow viral infection, certain medications, or pregnancy.
How common it is
Rare — about 10-20 per 100,000. More common in women (4:1). Often coexists with other autoimmune diseases (thyroid, celiac, IBD).
How it is diagnosed
Blood tests: very elevated ALT/AST, elevated IgG, autoantibodies (ANA, anti-SMA, anti-LKM). Liver biopsy is usually needed to confirm. Other liver diseases (viral, drug-induced, NASH) must be excluded.
Lifestyle and daily habits
Adherence to medications is critical.
• Take medications EXACTLY as prescribed — even when feeling well.
• Avoid alcohol entirely.
• Get vaccinated against hepatitis A and B.
• Bone density check — long-term steroids cause osteoporosis.
• Pregnancy planning is important — adjustment of meds may be needed.
Diet
Standard healthy diet.
• Mediterranean pattern.
• Adequate calcium and vitamin D for bone health on steroids.
Medicines
Two-drug induction then maintenance.
• Prednisone (high dose initially) + azathioprine (long-term steroid-sparing).
• Budesonide is an alternative steroid with fewer side effects in non-cirrhotic patients.
• Mycophenolate or tacrolimus for patients who don't tolerate azathioprine.
• Treatment is usually lifelong; trials of withdrawal possible after years of remission.
Procedures and surgery
Procedures address complications.
• Liver biopsy at diagnosis (and sometimes repeat).
• Liver transplant for end-stage disease.
Outlook
80% achieve remission with treatment. Lifelong therapy is usually needed. With good control, life expectancy is normal. Untreated AIH leads to cirrhosis and liver failure.
Questions to ask your doctor
• Will I need lifelong medication?
• Could I be tapered off steroids?
• Should I be screened for other autoimmune diseases?
Source and review
This guide comes from the Saudi Gastroenterology Association (SGA) patient library, prepared by the SGA Hepatology Panel. Last reviewed: 2026-04-24. It is for education and does not replace your doctor's advice.
Frequently Asked Questions
What is Autoimmune Hepatitis?
How is Autoimmune Hepatitis diagnosed?
What is the outlook for Autoimmune Hepatitis?
When should I see a doctor about Autoimmune Hepatitis?
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