Autoimmune Hepatitis

Causes & Risk Factors

AIH is thought to arise from a combination of genetic susceptibility and an immune-triggering event, resulting in the immune system attacking liver tissue.

•  Sex — AIH is more common in women than men, similar to many other autoimmune diseases.

•  Age — can occur at any age, from childhood through late adulthood, with two recognized types (Type 1 and Type 2) that tend to present at different ages.

•  Genetic predisposition — certain genetic markers are associated with increased susceptibility.

•  Coexisting autoimmune disease — AIH may occur alongside other autoimmune conditions, including thyroid disease, type 1 diabetes, or autoimmune conditions affecting the gut or joints.

•  Possible environmental triggers — certain infections or medications have been proposed as potential triggers in susceptible individuals, though this is not fully established.

Symptoms & When to Test

AIH may be discovered incidentally through abnormal liver enzymes, or may present with more specific symptoms of liver disease.

•  Persistent unexplained elevation of ALT or AST

•  Recurrent abnormal liver function tests

•  Unexplained hepatitis

•  Jaundice (yellowing of skin or eyes)

•  Elevated serum IgG

•  Unexplained fatigue

•  Other known autoimmune diseases with new liver test abnormalities

•  Features suggesting chronic liver disease

When Should You Consider Testing?

Testing may be considered in patients with persistent unexplained elevation of ALT or AST, recurrent abnormal liver function tests, unexplained hepatitis, jaundice, elevated serum IgG, other autoimmune diseases, suspected chronic liver disease, or liver abnormalities without an obvious cause.

Why Tests Are Combined

Abnormal liver enzymes can have many causes — viral hepatitis, fatty liver disease, alcohol-associated liver disease, drug-induced injury, hemochromatosis, Wilson disease, and other autoimmune liver diseases can all present similarly. A combination of investigations is therefore more useful than ordering a single autoimmune marker.

ANA and ASMA/SMA are commonly used together when evaluating suspected Type 1 AIH, since either can be positive, and both provide complementary supportive evidence.

Elevated Total IgG is an important supportive feature but is not specific to AIH on its own; it is interpreted together with autoantibodies, liver enzymes, and clinical findings (IgG + Autoantibodies + Liver Enzymes + Clinical Findings) rather than in isolation.

In autoantibody-negative or unclear cases, additional markers such as Anti-LKM-1 and Anti-SLA/LP may be added, since these can be positive even when the more common antibodies are negative — particularly relevant in suspected Type 2 AIH.

Tests Available at NPL

Which Tests Do I Need?

Abnormal ALT/AST With Suspected Autoimmune Cause

→ ALT

→ AST

→ Total IgG

→ ANA

→ ASMA/SMA

Suspected Type 2 Autoimmune Hepatitis

→ Total IgG

→ ANA

→ ASMA/SMA

→ Anti-LKM-1

Autoantibody-Negative or Unclear Cases

→ Total IgG

→ ANA

→ ASMA/SMA

→ Anti-LKM-1

→ Anti-SLA/LP

→ Additional evaluation based on clinical findings

Suspected Autoimmune Liver Disease / Cholestatic Pattern

→ ALT/AST

→ ALP/GGT

→ Bilirubin

→ ANA

→ AMA

→ IgG/other immunoglobulin assessment where indicated

Most autoimmune antibody tests and inflammatory markers do not require fasting. However, if your doctor has ordered other tests at the same time — such as glucose or lipid testing — fasting may be required for those investigations. Please follow the preparation instructions provided by your doctor or NPL.

Home Sample Collection

NPL offers convenient home sample collection for all Autoimmune Hepatitis tests, so you don't need to visit a lab in person.

→ Book your test online, via the NPL app, or by calling +977 1 5970147 and select a convenient time slot for home sample collection.

→ A certified and experienced NPL phlebotomist visits your home at the scheduled time, following strict hygiene and safety protocols.

→ Your sample is transported under controlled, monitored conditions to NPL's NABL ACCREDITED UNDER ISO 15189:2022 laboratory for processing.

→ Your digital report is delivered securely to your phone or email, along with access to download and share it as needed.

When to See a Doctor

•  Persistent unexplained elevation of liver enzymes

•  Jaundice (yellowing of the skin or eyes)

•  Unexplained fatigue combined with abnormal liver tests

•  Elevated IgG on routine blood work

•  Recurrent abnormal liver function tests

•  Known autoimmune disease with new abnormal liver tests

•  Unexplained chronic liver disease

•  Positive autoimmune liver antibodies on prior testing