Autoimmune hepatitis and pregnancy

[slc15asa5]

I am a 31 year old female and I have recently been diagnosed with autoimmune hepatitis.  I have been diagnosed with Sjogren's syndrome for about 10 years and am on Plaquenil 200mg per day.  My AST and ALT are twice normal, as is my IgG.  My liver biosy showed Grade 2 inflammation and Stage I fibrosis.  My current GI doc feels that there is no need to treat at this stage and that a wait and see approach is better.  He wants to monitor my LFT's and only start treatment if they become more elevated. I, however, would like to get pregnant and after researching this further am not sure that is the best treatment option.  Any help would be appreciated, as would any suggestions for specialists in the NYC area.

[SonicBandaid]

Hi slc15asa5,
First, the initial desirable end-point of the treatment of autoimmune hepatitis is normalisation of the liver function tests (meaning transaminases—ALT in this instance), hence most hepatologists would probably want to treat you unless there is some other issue in the background.

Second, I think you need other tests; if you are contemplating pregnancy (and this can be problematic for women with significant liver disease as they tend to be subfertile) it is important to exclude portal hypertension.  While this would seem unlikely on the basis of what you have said, it is worth an ultrasound with portal vein Doppler.  The point here is that pregnancy may exacerbate portal hypertension by increasing mesenteric blood flow, thus increasing your chance of bleeding from varices, if you had them.

Third, given the Sjogren's, I think it is worth testing to exclude other associated "autoimmune" disorders and this should include serology to reduce the likelihood of coeliac disease (that is associated with abnormal LFTs in a significant proportion of those affected) as well as primary biliary cirrhosis (that occasionally may be confused histologically with autoimmune hepatitis, but obviously has a different treatment and prognosis), and thyroid dysfunction.

I don't know of any good liver Docs in NYC personally, but I do know there are lots of truly excellent ones there.  The American Liver Foundation or the AASLD may be able to help you.
Hope this helps,
Sonic

[Here987]

Sonic has some very good advice. You wrote the previous message several months ago. I hope you've resolved your question about treatment by now. It may require getting a second opinion.  Most people diagnosed with AIH receive immediate treatment, to normalize their liver condition. However, situations differ; you may have other issues that make the usual treatment (Prednisone and another immunosuppressant such as Imuran), undesirable. Best wishes.