Autoimmune hepatitis in human immunodeficiency virus infection: Case report and literature review

Table 1 Simplified diagnostic criteria for autoimmune hepatitis, adapted from EASL Clinical Practice Guidelines: Autoimmune hepatitis, 2015

Parameter	Discriminator	Score
ANA or ASMA+	≥ 1:40	1
ANA or ASMA+	≥ 1:80	2
ANA or LKM+	≥ 1:40	2
ANA or SLA/LP+	Any title	2
IgG or gamma globulins	> ULN	1
	> 1.1 × ULN	2
Liver biopsy	Compatible with AIH	1
	Typical AIH	2
	Atypical	0
Absence of viral hepatitis	No	0
	Yes	2

Definitive autoimmune hepatitis ≥ 7; probable autoimmune hepatitis ≥ 6. Typical liver biopsy for autoimmune hepatitis: Each one of the following characteristics must be present: Interface hepatitis, lymphocytic/lymphoplasmacytic infiltrates in the portal tracts, and extending toward the lobes, emperipolesis (active penetration by a cell within another cell), hepatocyte rosettes formations. Liver biopsy consistent with autoimmune hepatitis: Chronic hepatitis with lymphoplasmacytic infiltrate without all the characteristics considered typical. Atypical liver biopsy: Signs of another diagnosis. ANA: Anti-nuclear antibodies; ASMA: Anti-smooth muscle antibodies; LKM: Liver kidney microsomal antibodies; SLA/LP: Antibodies to soluble liver antigen/pancreas; IgG: Immunoglobulin G; ULN: Upper limit of normal; AIH: Autoimmune hepatitis.

Table 2 Clinical characteristics of the cases reported

Author	Vasilios	Wan	Daas	Coriat	Puius	O'Leary	Hagel	Cazanave	Murunga
Patients reported (n)	1	4	1	1	3	1	1	1	9
Age (min/max) (yr)	38	49-56	42	48	29-65	44	52	43	23-45
Gender (M/F)	M	1-3	F	F	1-3	F	M	F	1-8
CD4+ cell count (cells/μL) (min/max)	216	174-357	157	250	200-259	269	641	500	253-876
HIV viral load at presentation (min/max) (copies/mL)	81000	< 50-232734	120000	No data	< 75-8687	< 50	UD	< 1000	UD-8
AST (min/max) (IU/L)	120	45-186	1526	No data	20-500	NO DATA	343	No data	13-34
ALT (min/max) (IU/L)	274	45-167	777	355	12-641	26-940	192	500	10-39
cART	Z, L, Nelfinavir	No data	F, T, Etravirine	R, E, Atazanavir	L (2), Z, E (3), F (1), T (1), stavudine	T, F, E	Didanosine, stavudine, E	L,Stavudine, E	E (7) F (6) T (8) L (3) N (1) Z (1) L/R (1)
Positive autoantibodies (n) dils	ANA 1:320 ASMA 1:40	ANA 1:20-40 ASMA(1)	ANA: 1:1280 ASMA(-)	ANA: 1:80 LKM: 1:320	ANA (2) 1:80-640 ASMA (1)	ANA 1:160	ANA: 1:2560	ANA: 1:8000 ASMA: 1: 4000	ANA (4), ASMA (6), ALKM (1)
Inmunoglobulin G (g/L)	29.25	639-2020	46	30	3050-7500	2640	39	Normal	16.5-55.2
Fibrosis	No	No	Yes	No	Yes	No	No	Yes	Yes
International AIH group score (min/max)	15	10-18	19	No data	10-15	22	15	No data	12-20
Treatment	No data	Prednisolone (4) Azathioprine (3)	Prednisone	Prednisolone	Prednisolone, Azathioprine	Prednisolone, Azathioprine	Prednisolone	Prednisolone, Azathioprine	Prednisolone
Publication Year	2005	2009	2011	2008	2008	2008	2012	2006	2016
Ref.	[10]	[11]	[12]	[13]	[14]	[15]	[16]	[17]	[18]

M: Male; F: Female; UD: Undetectable; ARV: Antiretroviral therapy; L: Lamivudine; E: Efavirenz; F: Emtricitabine (FTC); L/R: Lopinavir/Ritonavir; T: Tenofovir disoproxil fumarate; N: Nevirapine; Z: Zidovudine; ANA: Anti-nuclear antibodies; ASMA: Anti-smooth muscle antibodies; ALKM: Anti-liver kidney microsomal antibodies.