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Types of Autoimmune Hepatitis

My 18 year old daughter was diagnosed with Autoimmune Hepatitis in 2001.  Her ANA was positive at 4.1 and she had positive antibodies to liver/kidney microsome at 1:5120.  I am confused as to whether she has type I or type II.  Upon diagnosis, her first liver biopsy showed Grade 3 Stage 3 fibrosis.  She was in remission for two years and then had a second biopsy which showed well developed cirrhosis.  Is this normal for the physical condition of the liver to deteriorate even though her disease was in remission?
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Type 1, or classic autoimmune hepatitis, is characterized by circulating antibodies to nuclei (ANA) and/or smooth muscle (ASMA); the latter are thought to be reflective of more specific antiactin antibodies (AAA). AAA is not generally measured in most clinical laboratories, but ASMA with titers of 1:320 or greater almost always reflect the presence of AAA.

Type 2 autoimmune hepatitis is defined by the presence of antibodies to liver/kidney microsomes (ALKM-1).

Given the fact that the ALKM antibodies are present, it makes type 2 disease more likely.  

It may be possible for the liver to deteriorate although there were no outward signs of the disease.  Following up with the gastroenterologist is the next step.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.

Krawitt.  Classification of autoimmune hepatitis.  UptoDate, 2004.
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