Occurrence and Management of Opportunistic Infections in Patients With Autoimmune Hepatitis: A Spanish Multicentre Study

Abstract

Background: The management of autoimmune hepatitis (AIH) is based on immunosuppressive agents that may increase the risk of opportunistic infections (OI). However, data on their prevalence and incidence are lacking, which may explain the absence of specific management recommendations.

Aims: To characterise the screening, occurrence and treatment of OI in patients with AIH.

Methods: Retrospective multicentre study conducted in 20 Spanish centres involving patients with AIH treated with corticosteroid-based regimens.

Results: From 2000 to 2023, 2893 AIH patients were treated. Latent Tuberculosis Infection (LTBI) screening was performed in five out of 20 centres, identifying 37 patients with LTBI, of whom 15 (40.5%) received LTBI therapy. No treated or untreated LTBI patients developed active Tuberculosis (aTB). In contrast, only six patients (0.2%) from the entire cohort developed aTB during follow-up, with a median of 13.3 years from AIH diagnosis, without differences in risk factors or immunosuppressive therapy. Regarding other OI, no patient developed Pneumocystis jirovecii-related pneumonia, 14 patients (0.48%) developed invasive candidiasis and 16 patients (0.55%) experienced infection due to Aspergillus spp. Notably, invasive candidiasis predominantly occurred in chronic AIH (71.4%), whereas Aspergillus infections were associated with severe forms of AIH and an increased risk of death. Less frequent OI included those caused by viruses (Cytomegalovirus, Varicella Zoster and Herpes Simplex), bacteria (Nocardia and Listeria) or fungi (Cryptococcus).

Conclusions: The occurrence of OI in AIH is very low, suggesting that LTBI screening and treatment may be unnecessary. In contrast, Aspergillus infection seems to be associated with acute severe AIH with dismal prognosis.

Keywords: Pneumocystis jirovecii; autoimmune hepatitis; opportunistic infections; tuberculosis.