A 32-year-old woman is diagnosed with autoimmune hepatitis type 1 (ANA+, anti-SMA+, elevated IgG, interface hepatitis on biopsy). She is started on prednisolone and azathioprine. Her ALT normalises at 6 months. What defines COMPLETE remission in autoimmune hepatitis?
- A Normalisation of ALT alone
- B Normalisation of ALT, AST, IgG, and liver biopsy showing absent or minimal inflammation ✓
- C Disappearance of ANA antibodies
- D Normal ultrasound without hepatomegaly
Correct answer: B. Normalisation of ALT, AST, IgG, and liver biopsy showing absent or minimal inflammation
Explanation
Complete biochemical and histological remission in autoimmune hepatitis (per IAIHG criteria) requires normalisation of serum transaminases (ALT/AST), IgG levels, and liver biopsy showing no or minimal (grade 0–1) necroinflammatory activity. Biochemical remission alone is inadequate; ongoing histological inflammation predicts relapse. Antibody titres (ANA, SMA) are not used to define remission as they may persist. Treatment duration is typically at least 2 years beyond histological remission, after which gradual withdrawal can be attempted.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.