title: Diagnostic difficulties, therapeutic strategies, and performance of scoring systems in patients with autoimmune hepatitis and concurrent hepatitis B/C.
abstract: BACKGROUND
  The diagnosis of autoimmune hepatitis (AIH) is already difficult, and that of AIH with chronic viral hepatitis including hepatitis B (HBV) or hepatitis C (HCV) is even more challenging. To date, only a few case-based studies have described this association.
  
  
  OBJECTIVE
  The aim was to retrospectively assess diagnostic difficulties, therapeutic approaches, and performance of the scoring systems in AIH patients with concurrent HBV and HCV.
  
  
  METHODS
  A total of 25 patients from United States, Sweden, Italy, and Turkey were retrospectively evaluated. Both revised and simplified criteria suggested by the International Autoimmune Hepatitis Group were applied for each patient. All study data were obtained from medical records.
  
  
  RESULTS
  Of the 25 patients, 20 (80%) had concomitant HCV and 5 (20%) had HBV. Based on the revised scoring system and simplified criteria, 18 (72%) and 12 (48%) patients were diagnosed as "probable" AIH. None of the patients were diagnosed as "definite" AIH according to both scoring systems. Patients with HCV initially were treated with immunosuppressive agents, and antiviral therapy was commenced when biochemical remission occurred. AIH patients with HBV were first treated with antiviral and thereafter, immunosuppressive therapy was started.
  
  
  CONCLUSIONS
  This large case series describes concurrent AIH and chronic viral hepatitis. The revised scoring system for AIH had a better performance than the simplified scoring system. However, neither scoring system is optimal for diagnosing AIH alone. In these patients, a definitive diagnosis of AIH should be based on a combination of serological profiles, histological findings, scoring systems, treatment response, and outcomes.
authors: Department of Gastroenterology, Hacettepe University, Ankara, Turkey. drcumi21@hotmail.com
authors: Cumali
authors: C
authors: Efe
authors: Staffan
authors: S
authors: Wahlin
authors: Ersan
authors: E
authors: Ozaslan
authors: Tugrul
authors: T
authors: Purnak
authors: Luigi
authors: L
authors: Muratori
authors: Chiara
authors: C
authors: Quarneti
authors: Gonca
authors: G
authors: Tatar
authors: Halis
authors: H
authors: Simsek
authors: Paolo
authors: P
authors: Muratori
authors: Thomas D
authors: TD
authors: Schiano
mesh_terms: D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003937:Diagnosis, Differential; D004359:Drug Therapy, Combination; D005260:Female; D006509:Hepatitis B / Q000175:diagnosis* / Q000188:drug therapy; D006526:Hepatitis C / Q000175:diagnosis* / Q000188:drug therapy; D019693:Hepatitis, Autoimmune / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007558:Italy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013548:Sweden; D016896:Treatment Outcome; D014421:Turkey; D014481:United States
chemical_list: D000998:Antiviral Agents; D007166:Immunosuppressive Agents