Background: Autoimmune hepatitis (AIH) is a leading cause of chronic liver disease treated by immunosuppression namely, corticosteroids and azathioprine. In autoimmune liver diseases, in addition to the most common overlap syndromes of AIH/primary biliary cirrhosis (AIH/PBC) and AIH/primary sclerosing cholangitis (AIH/PSC), an AIH/viral hepatitis (AIH/VH) variant is distinguished. Chronic hepatitis B virus (HBV) infection is a major global health problem despite the availability of an efficacious vaccine. It is an immunopathic virus. Occult HBV infection is a complex clinical entity documented worldwide. Occult HBV (OHB) infection was not recognized as a clinical entity until the early 1990s.
Aim of the work: The aim of the study was to investigate the presence of occult hepatitis B virus in patients with autoimmune hepatitis, and also, the risk of occult HBV reactivation was investigated in patients with AIH and occult HBV treated by immunosuppression.
Subjects and Methods: 150 subjects were included in the study and divided into two groups: Group I included 50 patients with autoimmune hepatitis with or without cirrhosis and Group II included 100 healthy control subjects negative for hepatitis C virus antibody (HCV Ab) and hepatitis B surface antigen (HBs Ag) of matched age and sex. Patients and controls were investigated for the presence of occult hepatitis B. Patients having both autoimmune hepatitis and occult HBV who needed to be treated with immunosuppression were followed up for occult HBV reactivation for one year.
Results: Presence of Occult HBV was found to b e statistically significantly higher in patients with AIH than in controls (P=0.016), but no significant difference was found between cirrhotic AIH patients and non cirrhotic AIH patients (P=0.384). None of AIH and occult HBV patients treated with immunosuppression showed reactivation of HBV during follow up period of one year.
Conclusions: Presence of occult HBV is much higher in patients with autoimmune hepatitis than in healthy subjects. Also, immunosuppression for patients having both AIH and occult HBV is safe.