Type 1 Autoimmune Hepatitis in Taiwan: Diagnosis Using the Revised Criteria of the International Autoimmune Hepatitis Group

Abstract

Autoimmune hepatitis (AIH) is rare in Asian countries compared to the West, and an exceptionally low prevalence was noted previously in Taiwan. Using the revised criteria of the IAIHG, 48 cases of AIH patients were diagnosed. All patients were consecutively diagnosed over a period of 5 years. Detailed medical histories including disease onset, hepatitis B and C, alcohol, drugs, blood transfusion, and family history of autoimmune disease were recorded. Clinical manifestations, result of steroid therapy, outcome, and survival rate were investigated and analyzed. Clinical data on AIH patients with cirrhosis and without cirrhosis were compared and analyzed for their outcome. The statistical methods used were Fisher's exact test, Wilcoxon rank sum test, and Kaplan-Meier curve. Forty-eight patients were diagnosed as AIH type 1, with a median age of 58 years and a female:male ratio of 37:11. The most common clinical features at presentation were fatigue, jaundice, and anorexia. Ninety-eight percent of patients were ANA positive, and most of the patients showed elevated values of AST, ALT, serum globulin, and bilirubin. A substantial proportion of patients presented with poor liver function at entry and 35% of patients had liver cirrhosis, with relatively prolonged PT (P=0.001) and poorer outcome (P=0.005) compared to the noncirrhotics. As a whole there was a favorable treatment response and the overall survival rate was 85%. We conclude that the incidence of AIH in Taiwan is much higher than previously presumed and AIH type 1 is the predominant type of the disease. Although a substantial proportion of AIH patients presented with poor hepatic function at entry, as a whole there was a favorable clinical outcome.

Population-Based Prevalence, Incidence, and Disease Burden of Autoimmune Hepatitis in South Korea

“…The incidence and prevalence rates of AIH vary widely across different populations (Table 6). [1][2][3][4][5][6][7][8][9][10][11][12][13][14]16] The prevalence was highest in an Alaskan native population (42.9/100,000), modest in European and New Zealand populations (mainly Caucasians, 10.7-24.5/100,000), and low in populations from Singapore and Brunei (4-5.6/ 100,000). [1-6, 9, 10] The annual incidence rate was low in Taiwan and Israel (0.52-0.67/ 100,000) and relatively high in Europe (0.85-3/100,000).…”

“…[1-6, 9, 10] The annual incidence rate was low in Taiwan and Israel (0.52-0.67/ 100,000) and relatively high in Europe (0.85-3/100,000). [1,4,[8][9][10][12][13][14] Recently, a Japanese study reported a high prevalence and incidence of AIH (23.4/100,000 and 2.23/100,000/ year, respectively). [11] The wide variation seems attributable to differences between study populations as well as in the identification and definition of cases.…”

“…Prevalence estimates range widely from 4 to 42.9 cases per 100,000 persons [1][2][3][4][5][6][7][8][9][10][11], and reported annual incidences range from 0.67 to 2.23 cases per 100,000 persons. [1,4,6,[8][9][10][11][12][13][14] The variable results may be attributed to differences in genetics, environmental factors, and study population or design, and these heterogeneous factors make it challenging to understand the global epidemiology and disease burden of AIH.…”

Chronic Hepatitis in West and East

“…It was considered that AIH is a rare disease in Asian countries compared to the West; however, a recent study from Taiwan concluded that the incidence of AIH is much higher than previously presumed [11] . In Taiwan, as in Western countries, AIH type 1 is the predominant type of disease.…”

Similarities and Differences in Autoimmune Hepatitis Epidemiology between East and West: Autoimmune Hepatitis in East Asia, Southeast Asia, and South Asia

“…In Taiwan, the annual incidence of AIH was reported to be very low (0.52 cases/10 5 persons) [23] . Generally, AIH is suggested to be less frequent in Asian countries than in western countries, although we cannot deny the possibility that AIH is simply underrecognized in Asia, as many physicians in Asia tend to have less interest in AIH than in viral hepatitis.…”