Autoimmune hepatitis: the hidden liver disease many don't know about

Autoimmune hepatitis quietly damages the liver for years before symptoms appear; specialists in Kenya warn of late diagnoses and urge early medical checks. [File, Standard] When people think about liver disease, they imagine issues caused by drinking alcohol or infections like hepatitis B or C. What they may not realise is that there is another kind of liver disease. It is called autoimmune hepatitis, a condition where the immune system attacks the liver itself, causing inflammation and damage. The disease can get worse over years without signs, which means people can live with it without knowing until damage has been done. Liver disease remains a health challenge in Kenya, with hepatitis B and C dominating. Autoimmune hepatitis is gaining attention among specialists, though it remains uncommon and not well understood in the country. While statistics on autoimmune hepatitis in Kenya are limited, it is known as a liver disease where the immune system attacks the liver, causing inflammation. The condition is rare, and its prevalence in Kenya is unknown. Global studies suggest a prevalence between 0.010 per cent and 0.025 per cent in European populations, showing how uncommon the disease is compared to hepatitis. One challenge with autoimmune hepatitis is that the liver can take damage before symptoms show. Early signs can be vague. Fatigue, stomach discomfort or feeling unwell are easy to overlook or blame on something else. "You need to destroy about 70 to 80 per cent of the liver before signs and symptoms start to appear," explains Dr Christopher Opio, a liver specialist at Aga Khan University Hospital. He adds that this delayed presentation makes diagnosis difficult. By the time many patients come to hospital, their liver is already damaged, limiting treatment options and raising risks. The reasons why the immune system turns on the liver are unclear. Researchers believe it could be a mix of genetic factors, hormones and triggers from the environment, such as infections or certain medicines. Autoimmune hepatitis affects more women than men, and sometimes it runs in families, suggesting some inherited vulnerability. But despite studies, no single cause has been identified, which complicates efforts to prevent the disease or predict who might develop it. Diagnosing autoimmune hepatitis requires investigation because its symptoms and test results can overlap with other liver problems. Standard blood tests might show liver inflammation, but they will not point to autoimmune hepatitis. To confirm the diagnosis, doctors need to perform a liver biopsy where a piece of the liver is taken for examination under a microscope. This helps identify features of the disease and rules out other causes. Dr Opio notes that the disease is often missed or diagnosed late because its signs are subtle and many doctors may not consider it early enough. "We see a lot of delayed diagnosis and sometimes missed diagnosis. Sometimes you may have a smouldering autoimmune condition that gets worse when certain drugs are taken. It is important to be aware of this possibility, especially when the patient's condition suddenly worsens without a clear cause," he observes. If untreated, autoimmune hepatitis can lead to scarring of the liver, known as cirrhosis, which can lead to liver failure. This condition, Opio observes, may require a liver transplant to save the patient's life. Liver transplantation is still rare and complex in Kenya, and many patients seek treatment abroad. When a transplant does happen, it involves living donors, usually relatives who undergo medical and legal evaluations to ensure their safety and consent. Despite these challenges, detection and treatment with medication can control the immune attack, reduce inflammation and help people avoid surgery. Thanks to advances in medical knowledge and treatment, patients with autoimmune hepatitis now have better chances. Experts encourage anyone experiencing fatigue, abdominal discomfort or who has a family history of autoimmune diseases to seek medical advice.

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