What is hepatitis?
Hepatitis is an inflammation of the liver. Most often, hepatitis is caused by infection with certain viruses. However, liver inflammation can also result from exposure to chemicals, over-the-counter or prescription drugs, heavy alcohol use, inherited diseases, autoimmune disease, or fatty buildup in the liver.
Hepatitis can be acute, flaring up and then resolving within a few weeks to months, or chronic, enduring over many years.…
Hepatitis is an inflammation of the liver. Most often, hepatitis is caused by infection with certain viruses. However, liver inflammation can also result from exposure to chemicals, over-the-counter or prescription drugs, heavy alcohol use, inherited diseases, autoimmune disease, or fatty buildup in the liver.
Hepatitis can be acute, flaring up and then resolving within a few weeks to months, or chronic, enduring over many years. Chronic hepatitis may persist for 20 years or more before causing significant symptoms related to progressive liver damage, such as cirrhosis and liver cancer, and can cause death.
The liver is a vital organ located in the upper right-hand side of the abdomen. It performs many functions in the body, including processing the body’s nutrients, producing bile to help digest fats, synthesizing many important proteins, regulating blood clotting, and breaking down potentially toxic substances into harmless ones that the body can use or eliminate. In severe cases, liver inflammation may interfere with these processes and allow potentially toxic substances to build up.
The following table summarizes some common types of hepatitis. Click on the links to read more about the various types.
|Type of Hepatitis||Description||Examples of Causes|
|Viral||Infection with one of the hepatitis viruses causes inflammation; may be acute or chronic depending on virus.||In the U.S., most common causes are hepatitis A, B and C viruses.|
|Toxic or drug-induced||The liver processes many substances for the body to use and/or eliminate. The byproducts of this process can be toxic to the liver and may cause hepatitis. In other cases, hepatitis occurs with a drug that is not directly toxic to the liver but the body recognizes the drug as foreign and attacks it, causing hepatitis.||Alcohol, over-the-counter pain relievers, prescription drugs, herbal and vitamin supplements, industrial chemicals|
|Inherited||Certain gene mutations that are passed from one generation to the next can result in a disease that damages the liver, causing hepatitis.||Wilson disease, hemochromatosis, alpha-1 antitrypsin deficiency|
|Non-alcoholic fatty liver||Fat deposited in the liver cells in increasing amounts can lead to inflammation and liver injury, causing hepatitis.||Associated with metabolic syndrome|
|Autoimmune||The body’s immune system inappropriately produces antibodies directed against liver tissue, causing hepatitis.||Sometimes associated with other autoimmune diseases, such as type 1 diabetes, Hashimoto thyroiditis, pernicious anemia, or Sjögren syndrome|
Signs and Symptoms
The signs and symptoms of hepatitis are the same, regardless of the cause, but they may vary from person to person and over time. Most people with chronic hepatitis have no symptoms at all. Some people with acute hepatitis have no symptoms, but many have mild and/or vague symptoms that may be mistaken for the flu. Some of the more common signs and symptoms include:
- Abdominal pain
- Joint aches
- Yellowing of the eyes and skin (jaundice, the one symptom strongly suggesting liver damage as the cause of other symptoms)
Some people may experience additional signs and symptoms, such as loss of appetite, dark-colored urine, or light-colored stools. More serious complications can involve accumulation of fluid in the abdomen (ascites) and mental confusion.
A physical examination may reveal a liver that is tender and enlarged. In some people, chronic hepatitis can gradually damage the liver and, after many years, cause liver failure. The chronic form typically lasts for many years and rarely goes away without treatment.
There are several laboratory tests that may be performed in cases of known or suspected hepatitis. These tests may fall into one or more of the following categories:
- General chemistry tests to detect liver inflammation and/or damage
- Screening tests to detect viral hepatitis; for example, screening for exposure to hepatitis B or hepatitis C may be done because of increased risk of the disease (use of illegal drugs, multiple sex partners) or at the time of blood donation.
- Tests to help diagnose other underlying causes of hepatitis
- Tests to monitor the progression of liver damage and/or help guide treatment
Acute hepatitis is often suspected and testing done because of the appearance of signs and symptoms, such as fever, loss of appetite, and nausea, often accompanied by dark urine, pale stools, and yellow discoloration of the skin and the whites of the eyes (jaundice).
Chronic hepatitis may have no obvious signs and symptoms and is more commonly detected as a result of abnormal routine laboratory tests. These may include, for example, a comprehensive metabolic panel (CMP), a group of tests frequently ordered as part of a yearly health exam, or a liver panel.
The CMP and liver panel include several general blood tests that may be used to help evaluate the liver and detect hepatitis. They include:
- Alanine aminotransferase (ALT) – an enzyme found mainly in the liver. When the liver is damaged, ALT is released into the blood, usually before more obvious signs of liver damage occur, such as jaundice. This makes ALT a useful test for early detection of liver damage. Results are often compared to those of the AST test to help determine the cause of liver injury.
- Aspartate aminotransferase (AST) – also an enzyme found in the liver and a few other organs, particularly the heart and other muscles. The test is most useful in detecting liver damage due to hepatitis and may be elevated more than ALT with exposure to drugs toxic to the liver, cirrhosis, or alcoholism. AST, however, is not specific for the liver and may be increased in conditions affecting other parts of the body. Results are often compared to those of the ALT.
- Alkaline phosphatase (ALP) – an enzyme related to the bile ducts but also found in other tissues throughout the body. The ALP test is often increased when bile ducts are blocked but may also be increased with bone disorders.
- Bilirubin – a waste product made from the breakdown of old blood cells that is ultimately processed by the liver so that it can be eliminated from the body. Bilirubin is a yellow compound that can accumulate when the liver is damaged, causing jaundice and dark urine.
- Albumin – the main protein made by the liver. Since albumin is produced by the liver, its level can decrease with loss of liver function; however, this typically occurs only when the liver has been severely affected. Many other conditions also affect albumin level.
- Total protein – albumin and all other proteins in blood; may be decreased with severe liver disease.
Depending on the healthcare practitioner and the laboratory, other tests that may be done individually or as part of a liver panel include:
- Prothrombin time (PT) – this test may be ordered for a person with hepatitis or suspected hepatitis. Proteins used in the formation of a blood clot (coagulation factors) are mostly produced by the liver, and a prolonged PT may indicate the severity of liver damage.
- Gamma-glutamyl transpeptidase (GGT) – an enzyme found in the liver that is very sensitive to changes in liver function. The GGT test helps to differentiate between the causes of an elevated ALP; if GGT is increased, then the elevated ALP is due to liver, not bone disease.
- Lactate dehydrogenase (LD) – an enzyme released with cell damage; found in cells throughout the body.
- Alpha-feto protein (AFP) – associated with regeneration or proliferation of liver cells.
While the general tests listed above may help detect hepatitis, they do not determine the underlying cause. Additional testing may be necessary to pinpoint the cause and help direct treatment. Some examples include:
- Acute hepatitis panel – may be used to help detect infection with a hepatitis virus
- Autoimmune antibodies (e.g., ANA, ASMA, anti-LKM-1) – associated with autoimmune hepatitis
- Liver biopsy – this is a procedure in which a needle is inserted into the liver to withdraw a small amount of tissue that is examined under a microscope by a pathologist; it is the most definitive way to diagnose liver damage. Since this is an invasive procedure, it is used primarily when other tests are inconclusive or to determine how much liver damage has occurred. (For more information, read the article on Anatomic Pathology.)
Imaging tests, such as ultrasound and specialized X-rays, may be used to evaluate the liver, detect hepatitis, help make a diagnosis, and help determine a cause of liver injury. For more information about these procedures, visit the web site RadiologyInfo.org.
Infection with a virus is a common cause of hepatitis. The five viruses primarily associated with hepatitis are named in the order of their discovery: A, B, C, D, and E. In the United States, acute viral hepatitis is most commonly caused by hepatitis A virus (HAV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Only HBV and HCV infection commonly cause chronic hepatitis.
Hepatitis A (HAV) is highly contagious and is spread through water and food that have been contaminated with the hepatitis A virus. HAV infection rates have steadily declined since 1995, when a vaccine was introduced. In 2014, about 1,200 acute cases of hepatitis A were reported nationwide to the Centers for Disease Control and Prevention (CDC). Actual numbers may have been higher, however, since people with no symptoms or only mild symptoms may not have realized they were infected. The CDC estimates that the number of infections in 2014 was probably closer to 2,500 once corrected for underreporting and asymptomatic infections.
Hepatitis A causes an acute infection but not a chronic form of the disease. Treatment usually involves supportive therapy only, and most people recover fully within about six months. Early in the course of HAV infection, the body develops antibodies to the virus, so after the infection has resolved, a person will have lifelong immunity from the disease.
Hepatitis B (HBV) can be spread by contact with the blood, semen, or another body fluid from an infected person. In North America and Europe, the virus is most often spread by sharing needles, syringes, or other equipment used to inject drugs; through sexual contact; and from mother to child during pregnancy (rarely in the U.S., but commonly in many parts of the world).
Infection with the hepatitis B virus formerly was the most common cause of acute viral hepatitis in the United States, but vaccination has led to gradually decreasing rates. According to the CDC, there were about 19,200 new cases of HBV infection in the United States in 2014. The official number of reported hepatitis B cases is much smaller, however, because many people don’t know they are infected and never seek medical attention. HBV infection rates are highest among adults, particularly men aged 25-44.
The likelihood of an acute HBV infection becoming a chronic infection depends largely upon the age at which a person becomes infected. The younger a person is when he or she becomes infected, the more likely the infection will become chronic. About 90% of infants who acquire the disease will develop chronic infections. Conversely, less than 5% of adults who become infected with HBV progress to chronic hepatitis B.
Treatment for acute HBV infection usually involves supportive therapy only, and most people recover fully within about six months. Early in the course of HBV infection, the body develops antibodies to the virus, so after the infection has resolved, a person will have lifelong immunity from the disease.
People who develop chronic hepatitis B often remain free of signs and symptoms of illness for decades. Drug treatment may help slow the development or progression of liver damage caused by chronic infection. Liver transplantation may be performed in cases of liver failure.
Hepatitis C (HCV) is spread by exposure to contaminated blood. The most common mechanism of exposure to HCV is the sharing of needles used in injecting drugs of abuse such, as cocaine or heroin. Other means of becoming infected include occupational exposure of healthcare workers via used needles or other sharp objects; through sexual activity that results in tissue tears; from mother to baby during childbirth; and through the sharing of personal items contaminated with blood, such as razors and toothbrushes.
In 2014, there were about 30,500 cases of acute hepatitis C in the United States. Many cases are not reported and many people do not know that they have an infection because they have no symptoms. Of those who become infected, about 75-85% develop the chronic form of hepatitis C. According to the CDC, there are an estimated 3.5 million people in the U.S. who have chronic hepatitis C. About 60-70% of people with untreated chronic hepatitis C will develop chronic liver disease. Without treatment, roughly 5-20% will develop cirrhosis over many years, and 1-5% are estimated to die from a condition that results from chronic infection, such as cirrhosis or liver cancer.
There is no vaccine available to prevent hepatitis C, but research is in progress to develop one. Currently, the best way to avoid becoming infected is to limit exposure to possible sources of the virus, especially the sharing of needles to inject drugs. Both acute and chronic HCV can be treated, usually with a combination of drugs (see Treatment below).
Hepatitis D and E are rare in the U.S. Hepatitis D only causes an infection when hepatitis B is present and can make that infection more severe. It is usually spread by exposure to infected blood or needles. Hepatitis E is spread in a similar fashion to hepatitis A and is found primarily in Asia, the Middle East, Africa, and Central and South America, although increasing numbers of cases are being recognized in persons in the United States who have not traveled to these areas. Hepatitis E can rarely cause chronic hepatitis in persons whose immune system is not working properly.
Signs and symptoms of viral hepatitis correspond to those of hepatitis in general. See the section on Signs and Symptoms for detailed information.
A variety of blood tests are available to help diagnose and/or monitor hepatitis caused by specific hepatitis viruses. For testing information on the most common causes of viral hepatitis, see the pages on hepatitis A, B, and C, or see the summary information in the table below.
Summary Table: Most common causes of viral hepatitis
|Virus||Hepatitis A||Hepatitis B||Hepatitis C|
|Transmission route||Fecal-oral||Infected blood, semen, or other body fluids||Infected blood, semen, or other body fluids|
|Incubation time (acute infection)||15-50 days||60-150 days||14-180 days|
|Onset||Sudden||Either sudden or slow, unnoticed||Usually slow, unnoticed|
|Severity||Mild||Occasionally severe||Usually slow-developing and symptoms not specific or strong|
|Associated with other diseases?||None||Liver cancer, cirrhosis||Liver cancer, cirrhosis|
|Testing to Diagnose Acute Infection||HAV-Ab, IgM||HBsAg, Anti-HBc, IgM||Anti-HCV, HCV RNA (Note: may have same results as in chronic hepatitis)|
|Testing to Diagnose Chronic Infection or to Monitor Treatment||N/A||HBsAg, HBV DNA, HBeAg, Anti-HBe||Anti-HCV (once), HCV RNA or viral load, HCV genotype (once)|
|Tests that Detect Previous Infection||HAV-Ab, IgG||Anti-HBs, Anti-HBc total||Anti-HCV|
|Common Treatment||None||Chronic form: Interferon, entecavir, tenofovir, lamivudine, adefovir||Treatment for acute HCV is similar to the chronic form. However, the best regimen and when to start treatment remains uncertain. Chronic HCV is usually treated with a combination of drugs. Some examples include a pill containing sofosbuvir and ledipasvir, and a multiple drug regimen containing ombitasvir, dasabuvir, paritaprevir, and ritonavir; a number of other combinations have been approved by the FDA recently, and more are likely to come in the future. Treatments may differ depending on a variety of factors, including HCV genotype and the health of the person’s liver.|
The incidence of new cases of viral hepatitis has decreased due to use of safer injection and sex practices (important in preventing hepatitis B and C) and the availability of vaccines for hepatitis A and hepatitis B (there is currently no vaccine available for hepatitis C). Screening units of blood for hepatitis B and C has virtually eliminated infections through blood transfusions. A systematic program to screen pregnant mothers for hepatitis B and to vaccinate all newborns has greatly decreased new cases of hepatitis B.
Support and symptom relief are frequently the only treatments required for acute hepatitis A. This usually involves plenty of rest, fluids, and nutritious food. With hepatitis A, most people recover without complications.
Management of acute hepatitis B is primarily supportive and usually involves plenty or rest and fluids and good nutrition. For those who progress to the chronic form of hepatitis B, management goals include minimizing further damage to the liver, treating underlying conditions that are causing or exacerbating the condition, and preventing transmission of the virus. There are medications available to treat chronic hepatitis B, but not all people need to be treated. People with chronic hepatitis are closely monitored for the development of liver cirrhosis or cancer.
About 75-85% of people with acute hepatitis C develop the chronic form and both forms can be treated, usually with a combination of drugs. Though acute HCV can be cleared by some people without medications, treatment reduces the risk that the infection will become chronic. The same drugs used to treat chronic hepatitis C are used to treat the acute form, but the best treatment for acute HCV and when to start it remains uncertain.
The approach to treating chronic hepatitis C varies based on the genetic makeup (genotype) of HCV that is causing the infection, whether a person has previously been treated for HCV infection, the health of the person’s liver, and other factors.
Toxic or Drug-Induced Hepatitis
The liver is responsible for the metabolism of alcohol, drugs, and every other chemical to which a person is exposed, breaking them down into substances that can be used and/or eliminated from the body. This process rarely produces byproducts that can harm the liver, resulting in hepatitis. Symptoms of toxic hepatitis often appear quickly, within hours or days of exposure to a substance, while with drug-induced hepatitis, they develop slowly after repeated use of alcohol, a drug, or exposure to a chemical.
Examples of substances that are directly toxic (or have byproducts made in the liver that are directly toxic) to the liver include industrial solvents, cleaning solvents, pollutants and some drugs. Acetaminophen, which is found in numerous over-the-counter and prescription medications, is an example of a drug that can cause toxic hepatitis. In therapeutic doses, acetaminophen is a useful pain reliever, but in very high doses or in combination with alcohol, it has the potential to cause life-threatening acute liver failure.
Examples of commonly used products that are capable of causing drug-induced hepatitis include:
- Aspirin, ibuprofen, and naproxen sodium (especially if combined with alcohol)
- Herbal supplements, including cascara, chaparral, comfrey, kava and ephedra
- Large doses of vitamin supplements
Excessive consumption of alcohol is a common cause of drug-induced hepatitis. The liver inflammation may be chronic yet mild, lasting for years with no specific symptoms. However, over time, the liver may sustain more and more damage. The rate of mortality in severe cases of alcohol-induced hepatitis (also called alcoholic steatohepatitis) is about 50%. The damage may be reversed if alcohol consumption is stopped.
Many prescription drugs have the potential to cause drug-induced hepatitis. Their effect on the liver cannot be foreseen and appears to be related to an immune reaction to the medication. The list of prescription drugs that can damage the liver is long and continues to grow. Among them are certain anesthetics, antibiotic and antifungal medications, anabolic steroids, drugs used to lower cholesterol, chemotherapy drugs, and seizure medications.
Signs and symptoms of toxic and drug-induced hepatitis vary depending on the cause. They may appear suddenly or develop gradually with prolonged exposure to a drug or other toxin. When present, signs and symptoms often correspond to those of hepatitis in general. See the section on Signs and Symptoms for detailed information.
The diagnosis of toxic and drug-induced hepatitis is often arrived at for a patient with hepatitis by obtaining a full medical history that focuses on the use of over-the-counter and prescription medications, herbs, and vitamin supplements; alcohol use; and, where applicable, evaluating hazards the patient may have been exposed to in the workplace, such as industrial solvents. Tests that may be performed to help evaluate patients with toxic hepatitis include the following:
- Liver panel – to evaluate liver function and/or determine the extent of liver damage
- Ethanol level – if alcohol is suspected to be a cause
- Emergency and overdose drug testing – including tests for drugs of abuse, acetaminophen, and therapeutic drugs to help determine the cause of hepatitis and guide treatment
- Liver biopsy – to determine the type and extent of liver damage
There is no specific treatment for most kinds of toxic or drug-induced hepatitis. Usually, discontinuing use of alcohol or the medication that is causing the liver damage or avoiding exposure to toxins is the first step. Many people fully recover from this type of hepatitis if exposure is restricted soon enough, although it may take months for the liver to heal. In severe cases, hospitalization may be required while the liver heals. Occasionally, there is lasting damage, such as cirrhosis and even liver failure. If the liver is irreversibly damaged, then a liver transplant may be an option.
There is treatment available for an overdose of acetaminophen that can minimize damage to the liver. N-acetylcysteine (NAC) may be given as an antidote within 24 hours of ingestion. It is most effective as an antidote if given within 8 hours of ingestion, so it is important to identify and treat this condition as soon as possible.
Inherited Forms of Hepatitis
Several inherited diseases affecting the liver can become apparent, primarily by causing symptoms of acute or chronic hepatitis. Some examples include:
- Hemochromatosis is the most common form of inherited hepatitis and is associated with absorption and accumulation of too much iron in the body. The liver is one of the principal organs damaged, and chronic hepatitis may be due to iron overload.
- Alpha-1-antitrypsin deficiency is the most common genetic cause of liver disease in children. In adults, the disorder is more likely to affect the lungs, but cirrhosis and liver cancer are both more common in those with alpha-1-antitrypsin deficiency.
- Wilson disease is a rare inherited disorder that causes a buildup of excess copper in the liver, brain, kidneys, and eyes. This disease may cause both acute and chronic hepatitis. Unless Wilson disease is treated, it becomes progressively worse and is eventually fatal.
Click on the links above to read more about the specific conditions listed.
Signs and symptoms of inherited forms of hepatitis are varied and specific to the individual diseases. Click on the links above to find out more about them. Signs and symptoms of the liver involvement in these conditions correspond to those of hepatitis in general. See the section on Signs and Symptoms for detailed information on those.
Inherited hepatitis may be suspected if there is a family history of liver disease. Some common tests to look for the presence of inherited liver diseases include:
- Iron tests such as serum iron, total iron binding capacity (TIBC), and ferritin to help diagnose hemochromatosis.
- Alpha-1-antitrypsin level to look for alpha-1-antitrypsin deficiency.
- Ceruloplasmin and copper tests can help diagnose Wilson disease. The body normally eliminates excess copper into the bile but also binds some to an enzyme called ceruloplasmin. With Wilson disease, the binding and excretion processes do not work properly, resulting in decreased concentrations of ceruloplasmin in the blood but increased concentrations of free copper in the blood, urine, and liver.
- Genetic testing – these tests may be used to detect mutations in certain genes that can lead to inherited types of hepatitis. Tests for mutations in the HFE gene, for example, can help diagnose hemochromatosis.
- Liver biopsy – microscopic examination of a sample of liver tissue can help make a diagnosis.
There is no cure for genetic diseases that affect the liver. Treatments depend on the cause and are as varied as the conditions. For example, hereditary hemochromatosis treatment usually involves periodic phlebotomy where a pint of blood is removed from the affected person to decrease the amount of iron in the body. Those affected by Wilson disease may be put on a low copper diet and treated with drugs to help eliminate copper from the body or prevent its absorption from the diet. For more on their specific treatments, click on the links in the bulleted list of diseases above.
Non-Alcoholic Fatty Liver Disease (NAFLD) and Nonalcoholic Steatohepatitis (NASH)
One of the most common causes of chronic hepatitis is the accumulation of excess fat in the liver. The condition develops gradually, typically over several years, with the intake of too many calories. Sometimes, the first sign is abnormal results on routine blood tests. A liver biopsy may be ordered in cases in which the liver is enlarged after viral or other causes of hepatitis have been ruled out. If the biopsy reveals that liver tissue is excessively fatty, inflamed, and showing signs of damage, the condition is called nonalcoholic steatohepatitis (NASH). If a fatty liver is otherwise healthy and showing no signs of inflammation or scarring, the condition is called non-alcoholic fatty liver disease (NAFLD). NASH can be severe and can lead to cirrhosis in the liver. NAFLD typically causes no long-term harm in most patients, although a small percentage will develop progressive liver damage.
These conditions are most commonly seen in people with metabolic syndrome, a combination of health problems such as obesity (especially too much fat in the belly), hypertension, high triglyceride levels, low HDL cholesterol, and insulin resistance or type 2 diabetes. Currently, there is no specific treatment for either condition; however, those affected are typically encouraged to reduce their weight by increasing physical activity and following a healthy diet.
Signs and symptoms are usually not apparent in people with hepatitis caused by non-alcoholic fatty liver disease. When present, the signs and symptoms are generally mild but may also correspond to those of hepatitis in general. See the section on Signs and Symptoms for detailed information.
A fatty liver may first be detected when routine tests such as a comprehensive metabolic panel (CMP) or a liver panel are performed for other reasons. Abnormal test results may be the first indication that there is a problem with the liver. Imaging tests such as ultrasound, CT scan, or MRI may detect some fat in the liver. Often, several laboratory tests are done to rule out other causes, such as alcohol or hepatitis C. However, there are no laboratory tests that can make the diagnosis of NAFLD or NASH other than a liver biopsy.
There is no specific treatment for non-alcoholic fatty liver disease. There are some things that can be done that often lead to improvement in the condition of the liver:
- Weight loss in those who are obese
- Good glucose control in those who have diabetes
- Avoiding alcohol
- Some studies suggest that drugs that decrease insulin resistance may be helpful.
Autoimmune hepatitis is usually a chronic form of hepatitis that frequently leads to progressive liver damage. However, in about 10-20% of cases, it may present like acute hepatitis. For reasons that are not fully understood, the body’s immune system targets and attacks the liver. It is more common in women than men; in fact, according to the American Liver Foundation, 70% of those affected are female, usually between the ages of 15 and 40.
There are two forms of autoimmune hepatitis. The more common form is type I, which most often affects young women and may be found in association with other autoimmune disorders, such as type 1 diabetes, ulcerative colitis, and Sjogren syndrome. Type II is much less common and has been found to affect mostly girls between the ages of 2 and 14; it is more common in Europe than in the U.S.
Signs and symptoms of autoimmune hepatitis correspond to those of hepatitis in general. See the section on Signs and Symptoms for detailed information.
Several tests for various autoantibodies may be ordered to help diagnose autoimmune hepatitis and to look for other associated autoimmune disorders. The most common of these include:
- Antinuclear antibodies (ANA)
- Anti-smooth muscle antibodies (ASMA) and anti-actin antibodies — the majority of smooth muscle antibodies produced with autoimmune hepatitis is specifically directed against a protein called actin or F-actin. Testing is available for specific actin autoantibodies, but it is not available in every laboratory.
- Antibodies to liver and kidney microsomes (anti-LKM1)
Typically, people who have type I autoimmune hepatitis have ANA, ASMA, or both, and people who have type II have anti-LKM1.
Treatment for autoimmune hepatitis usually involves drugs that suppress the immune system and block the body from producing autoantibodies, limiting the inflammation caused by autoimmune reactions. This includes medications such as prednisone and azathioprine, although these treatments may not be effective in all cases. People who do not respond to these drugs or who develop severe side effects from the medications may be prescribed other immunosuppressive drugs such as mycophenolate mofetil, cyclosporine, or tacrolimus.
Typically, autoimmune hepatitis can be controlled with these medications but cannot be cured. People with this disease must often take these medications for many years and, in some cases, for life. If medication is stopped, the disease may return. These medications do have some side effects associated with their use. People with mild forms of this disease may not be treated with these drugs.
In some people, autoimmune hepatitis progresses to cirrhosis and end-stage liver failure, and a liver transplant may be necessary.
Sources Used in Current Review
Centers for Disease Control and Prevention (27 August 2015 updated). Hepatitis A FAQs for the Health Professionals. Available online at http://www.cdc.gov/hepatitis/hav/havfaq.htm#general. Accessed April 24, 2016.
Centers for Disease Control and Prevention (16 December 2015 updated). Hepatitis B FAQs for the Health Professionals. Available online at http://www.cdc.gov/hepatitis/hbv/hbvfaq.htm. Accessed April 24, 2016.
Centers for Disease Control and Prevention (31 May 2015 updated). Hepatitis A FAQs for the Health Professionals. Available online at http://www.cdc.gov/hepatitis/hcv/index.htm. Accessed April 25, 2016.
Centers for Disease Control and Prevention (8 December 2015 updated). Hepatitis D FAQs for the Health Professionals. Available online at http://www.cdc.gov/hepatitis/hdv/index.htm. Accessed April 25, 2016.
Centers for Disease Control and Prevention (28 August 2015 updated). Hepatitis E FAQs for the Health Professionals. Available online at http://www.cdc.gov/hepatitis/hev/index.htm. Accessed April 25, 2016.
Pagana, Kathleen D., Pagana, Timothy J., and Pagana, Theresa N. (© 2015). Mosby’s Diagnostic and Laboratory Test Reference. 12th Edition: Mosby, Inc., Saint Louis, MO. Pp 21-22, 29-30,452-453.
U.S. Food and Drug Administration (1 May 2015 updated. ) Hepatitis B and C Treatments. Available online at http://www.fda.gov/forpatients/illness/hepatitisbc/ucm408658.htm. Accessed April 25, 2016.
National Institute of Diabetes and Digestive and Kidney Diseases. LiverTox. Available online at http://livertox.nih.gov/intro.html. Accessed April 25, 2016.
Mayo Clinic (1 June 2013). Toxic Hepatitis (1 June 2013 updated). Avalable online at http://www.mayoclinic.org/diseases-conditions/toxic-hepatitis/basics/definition/con-20026939. Accessed April 26, 2016.
University of Maryland School of Medicine Institute of Human Virology. Drug-induced Hepatitis Information Guide. Available online at http://www.ihv.org/education/drug_hep.html. Accessed April 26, 2016.
University of Rochester Medical Center. Drug-induced Hepatitis. Available online at https://www.urmc.rochester.edu/Encyclopedia/Content.aspx?ContentTypeID=85&ContentID=P00668. Accessed April 26, 2016.
U.S. National Library of Medicine MedlinePlus (5 April 2016 updated). Drug-induced Hepatitis. Available online at https://www.nlm.nih.gov/medlineplus/ency/article/000226.htm. Accessed April 26, 2016.
American Liver Foundation (14 January 2015 updated). Alpha-1 Antitrypsin Deficiency. Available online at http://www.liverfoundation.org/abouttheliver/info/alphaone/. Accessed April 27, 2016.
U.S. National Library of Medicine Genetics Home Reference (26 April 2016 published). Alpha-1-antitrypsin-deficiency. Available online at https://ghr.nlm.nih.gov/condition/alpha-1-antitrypsin-deficiency. Accessed April 26, 2016.
American Liver Foundation (14 January 2015 updated). Wilson Disease. Available online at http://www.liverfoundation.org/abouttheliver/info/wilson/. Accessed April 27, 2016.
American Liver Foundation (14 January 2015 updated). Autoimmune Hepatitis. Available online at http://www.liverfoundation.org/abouttheliver/info/aihep/. Accessed April 27, 2016.
Mayo Clinic (30 December 2015). Autoimmune Hepatitis. Available online at http://www.mayoclinic.org/diseases-conditions/autoimmune-hepatitis/diagnosis-treatment/diagnosis/dxc-20167547. Accessed April 28, 2016.
National Institute of Diabetes and Digestive and Kidney Diseases (March 2014). Autoimmune Hepatitis. Available online at http://www.niddk.nih.gov/health-information/health-topics/liver-disease/autoimmune-hepatitis/Pages/facts.aspx. Accessed April 28, 2016.
American Liver Foundation (14 January 2015 updated). Non-alcoholic Fatty Liver Disease. Available online at http://www.liverfoundation.org/abouttheliver/info/nafld/. Accessed April 28, 2016.
National Institute of Diabetes and Digestive and Kidney Diseases (May 2014). Nonalcoholic Steatohepatitis. Available online at http://www.niddk.nih.gov/health-information/health-topics/liver-disease/nonalcoholic-steatohepatitis/Pages/facts.aspx. Accessed April 28, 2016.
NIDDK. Autoimmune Hepatitis. Available online at http://livertox.nih.gov/Phenotypes_auto.html.
Canadian Liver Foundation. Toxic Hepatitis. Available online at http://www.liver.ca/liver-disease/types/toxic-hepatitis.aspx.
Sources Used in Previous Reviews
Thomas, Clayton L., Editor (1997). Taber’s Cyclopedic Medical Dictionary. F.A. Davis Company, Philadelphia, PA [18th Edition]. Pp 884-886.
Pagana, Kathleen D. & Pagana, Timothy J. (2001). Mosby’s Diagnostic and Laboratory Test Reference 5th Edition: Mosby, Inc., Saint Louis, MO. Pp 477-480.
(2005 January 15, Reviewed). Viral Hepatitis B Fact Sheet. CDC, National Center for Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/ncidod/diseases/hepatitis/b/fact.htm.
(© 2005) Hepatitis and Liver Disease in the United States. American Liver Foundation [On-line information]. Available online at http://www.liverfoundation.org/db/articles/1008.
(© 2002-2003) Hepatitis A Factsheet. American Liver Foundation [On-line information]. Available online at http://www.liverfoundation.org/db/articles/1061.
(© 2002-2003) What is Autoimmune Hepatitis? American Liver Foundation [On-line information]. Available online at http://www.liverfoundation.org/db/articles/1011.
(© 2002-2003) Chemical and Drug Induced Liver Injury. American Liver Foundation [On-line information]. Available online at http://www.liverfoundation.org/db/articles/1056.
(2005 January 15, reviewed). Interpretation of the Hepatitis B Panel CDC. National Center for Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/ncidod/diseases/hepatitis/b/Bserology.htm.
(2005 January 15, reviewed). Hepatitis C Fact Sheet, CDC. National Center for Infectious Diseases [On-line information]. Available online at http://www.cdc.gov/ncidod/diseases/hepatitis/c/fact.htm.
(© 2005). Hepatitis B Virus (HBV). ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_291a.jsp#1150957.
Hart, J. (2003 October 3). Hepatitis. MedlinePlus Health Information Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/001154.htm.
(© 2005). ARUP Hepatitis A Virus (HAV). ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_290a.jsp#1150939.
Owens, T. (2005 February 9, Updated). Ceruloplasmin. MedlinePlus Medical Encyclopedia [On-line information]. Available online at http://www.nlm.nih.gov/medlineplus/ency/article/003662.htm.
(© 2005). Ceruloplasmin. ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.aruplab.com/guides/clt/tests/clt_a162.jsp.
(© 2002-2006). Ceruloplasmin (Cp) TECHNICAL UPDATE. Interpath Laboratory [On-line information]. Available online at http://www.interpathlab.com/TechnicalUpdates/ceruloplasmin.htm.
Twomey, P. et. al. (2005). Relationship between Serum Copper, Ceruloplasmin, and Non–Ceruloplasmin-Bound Copper in Routine Clinical Practice. Clinical Chemistry. 2005;51:1558-1559 [On-line journal]. Available online at http://www.clinchem.org/cgi/content/full/51/8/1558.
About Wilson’s Disease. Wilson’s Disease Association [On-line information]. Available online at http://www.wilsonsdisease.org/about%20wilsons%20disease.html.
(© 2005) Wilson Disease Screening Panel, Serum. ARUP’s User’s Guide [On-line information]. Available online at http://www.arup-lab.com/guides/ug/tests/0020598.jsp.
(© 2005) Free Copper (Direct) in Serum Ultrafiltrate. ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_a278.jsp#5461569.
(© 2005) Copper and Copper-Ceruloplasmin Index. ARUP’s Guide to Clinical Laboratory Testing [On-line information]. Available online at http://www.arup-lab.com/guides/clt/tests/clt_alp9.jsp#1155978.
(June 13, 2008) Centers for Disease Control and Prevention. Hepatitis A. Available online at http://cdc.gov/hepatitis/HAV/HAVfaq.htm#general. Accessed September 2009.
(July 8, 2008) Centers for Disease Control and Prevention. Hepatitis B. Available online at http://cdc.gov/hepatitis/HBV/HBVfaq.htm#overview. Accessed September 2009.
(July 21, 2008) Centers for Disease Control and Prevention. Hepatitis C, FAQs for Health Professionals. Available online at http://www.cdc.gov/hepatitis/HCV/HCVfaq.htm#section1. Accessed September 2009.
(December 17, 2008) Mayo Clinic. Toxic hepatitis. Available online at http://www.mayoclinic.com/health/toxic-hepatitis/DS00811. Accessed September 2009.
(Updated May 8, 2007) UCSF Medical Center. Toxic Hepatitis. Available online at http://www.ucsfhealth.org/adult/medical_services/liver/toxic/conditions/toxichep/treatments.html. Accessed September 2009.
(June 4, 2009) Mehta, N, et al. Drug-Induced Hepatotoxicity. eMedicine. Available online at http://emedicine.medscape.com/article/169814-overview. Accessed September 2009.
(September 28, 2007) American Liver Foundation. Alpha-1 Antitrypsin. Available online at http://www.liverfoundation.org/education/info/alphaone/. Accessed September 2009.
(September 28, 2007) American Liver Foundation. Wilson’s Disease. Available online at http://www.liverfoundation.org/education/info/wilson/. Accessed September 2009.
(March 14, 2007) American Liver Foundation. Hemachromatosis. Available online at http://www.liverfoundation.org/education/info/hemochromatosis/. Accessed September 2009.
National Institute on Alcohol Abuse and Alcoholism. Alcohol and the Liver. No. 19 PH 329 January 1993. Available online at http://pubs.niaaa.nih.gov/publications/aa19.htm. Accessed November 2009.
(September 28, 2007) American Liver Foundation. Alcohol-induce Liver Disease. Available online at http://www.liverfoundation.org/education/info/alcohol/. Accessed June 2009.
(September 12, 2008) Mayoclinic.com. Hemachromatosis. Available online at http://www.mayoclinic.com/health/hemochromatosis/DS00455. Accessed September 2009.
(February 19, 2009) Mayoclinic.com. Nonalcoholic fatty liver disease. Available online at http://www.mayoclinic.com/health/nonalcoholic-fatty-liver-disease/DS00577. Accessed October 2009.
(September 27, 2007) American Liver Foundation. Fatty Liver. Available online at http://www.liverfoundation.org/education/info/fattyliver/. Accessed October 2009.
(February 28, 2007) McAvoy N, et al. Non-alcoholic Fatty Liver Disease: Natural History, Pathogenisis and Treatment. Medscape Today from British Journal of Diabetes and Vascular Disease. 2006;6(6):251-260. Available online at http://www.medscape.com/viewarticle/552003. Accessed October 2009.
(August 22, 2008) Younossi Z. Review Article: Current Management of Non-Alcoholic Fatty Liver Disease and Non-Alcoholic Steatohepatitis. Medscape Today. Available online at http://www.medscape.com/viewarticle/578709. Accessed October 2009.
(September 12, 2007) American Liver Foundation. Autoimmune hepatitis. Available onlien at http://www.liverfoundation.org/education/info/aihep/. Accessed October 2009.
National Digestive Disease Information Clearinghouse. Autoimmune hepatitis. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/. Accessed October 2009.
University of Wisconsin, School of Medicine and Public Health. Health Information: Autoimmune liver disease panel. Available online at http://apps.uwhealth.org/health/hie/1/003328.htm. Accessed October 2009.
(May 23, 2006) Czaja A. Autoimmune Hepatitis – Approach to Diagnosis, MedScape Today. Available online at http://www.medscape.com/viewarticle/524097. Accessed October 2009.
Harrison’s Principles of Internal Medicine. 16th ed. Kasper D, Braunwald E, Fauci A, Hauser S, Longo D, Jameson JL, eds. McGraw-Hill, 2005 Pp 1822-1828, 1838-1841, 1869-1872.
(October 14, 2015) Centers for Disease Control and Prevention. Hepatitis C FAQs for Health Professionals. Available online at http://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#d3. Accessed December 2015.
(October 15, 2015) Centers for Disease Control and Prevention. Hepatitis C FAQs for the Public. Available online at http://www.cdc.gov/hepatitis/hcv/cfaq.htm#cFAQ61. Accessed December 2015.
Centers for Disease Control and Prevention. Viral Hepatitis Statistics & Surveillance. Available online at http://www.cdc.gov/hepatitis/Statistics/2011Surveillance/Commentary.htm#hepB. Accessed 9/1/2013.
National Digestive Diseases Information Clearinghouse (NDDIC). Nonalcoholic Steatohepatitis. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/nash/#treatment. Accessed 9/2/2013.
Fischbach, F.T., (2004) A Manual of Laboratory & Diagnostic Tests. 7th Edition., Lippincott Williams & Wilkins, Philadelphia.
Henry’s Clinical Diagnosis and Management by Laboratory Methods. 22nd ed. McPherson R, Pincus M, eds. Philadelphia, PA: Saunders Elsevier: 2011, Pp 308-309.
(February 16, 2012) National Digestive Diseases Information Clearinghouse. Autoimmune Hepatitis. Available online at http://digestive.niddk.nih.gov/ddiseases/pubs/autoimmunehep/. Accessed October 2013.
(October 4, 2011) American Liver Foundation. Autoimmune Hepatitis. Available online at http://www.liverfoundation.org/abouttheliver/info/aihep/. Accessed October 2013.