The clinical features, pathological assessment, and prognostic analysis of autoimmune hepatitis in Chinese persons living with HIV.

purposeAutoimmune hepatitis (AIH) is an uncommon condition among persons living with HIV (PLWH), and its clinical presentation may be influences by immune reconstitution and viral reactivation, potentially affecting disease course and prognosis. In this retrospective case series, we aimed to describe the clinical features, pathological findings, treatment approaches, and outcomes of PLWH diagnosed with AIH in Yunnan Province, China, with a focus on region-specific clinical features.

methodThis single-center retrospective case series included PLWH diagnosed with AIH at Yunnan Provincial Infectious Diseases Hospital between June 2017 and February 2025, based on electronic medical records. AIH was diagnosed according to the simplified International Autoimmune Hepatitis Group criteria (definite ≥ 7 points; probable ≥ 6 points), with cases lacking liver biopsy classified as probable AIH. PLWH with other chronic liver diseases, substantial missing data, or follow-up shorter than 15 months were excluded.

resultAmong the eight PLWH, seven were female, with a median age of 46.5 years (IQR 39-51). All PLWH had been living with HIV for more than 5 years and were receiving antiretroviral therapy with well-controlled viral loads. Elevated transaminase and immunoglobulin G (IgG) levels were observed in all cases, and four of them presented with jaundice. All cases tested positive for ANA and ASMA autoantibodies; three were positive for LKM-1, two for SLA, and five for EBV-DNA (62.5%), which appeared higher than the ~ 20% reported in the general AIH population. Three PLWH (37.5%) had concomitant autoimmune diseases, including rheumatoid arthritis, Sjögren syndrome, and hyperthyroidism. Serum IL-6 (median 18.9 pg/mL, IQR 14.7-27.8) and IL-7 (median 10.2 pg/mL, IQR 8.7-13.1) levels were elevated. Liver biopsies was performed in six cases, showing inflammatory activity grades A1-A3 and fibrosis stages F0-F4, all consistent with typical features of AIH. The remaining two cases were classified as probable AIH based on the simplified criteria. One PLWH with advanced disease (A3/F4) died early due to acute hepatic failure. Among the six PLWH who received immunosuppressive therapy, five achieved complete remission and one (complicated with Sjögren syndrome) had an incomplete response. During a follow-up of 15-24 months, no relapse was observed in PLWH who achieved complete remission, and SF-36 scores improved.

conclusionIn PLWH in Yunnan, China, AIH presents with complex clinical features and may be potentially associated with EBV reactivation and systemic inflammation. However, the small sample size and retrospective design preclude causal inference. Our findings support the value of early non-invasive assessment and generate a hypothesis regarding the potential role of EBV monitoring. Future multiventer prospective cohorts or randomized controlled trials are required to calidate the long-term safety and efficacy of immunosuppressive therapy.