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Questions for Your Doctor

Learn important questions to ask your healthcare provider if you or a loved one is diagnosed with autoimmune hepatitis (AIH).

Are you comfortable treating AIH patients? 

Should I consider seeing a hepatologist (if your current provider is not one)? Most AIH patients are treated by a gastroenterologist or a hepatologist. Hepatologists affiliated with liver transplant centers are likely more knowledgeable about harder-to-treat AIH patients. If you need a recommendation for a doctor, check out our list of Preferred Doctors or send us an email at info@aihep.org.

Can I take budesonide?

Is budesonide an option for me to take as an alternative to prednisone? Budesonide is now a first-line medication for AIH but is typically only appropriate for patients who don’t have cirrhosis.

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Will you check my TPMT enzyme prior to prescribing azathioprine?

TPMT is the enzyme that metabolizes azathioprine and can have different levels of activity that help determine the appropriate dose of azathioprine for doctors to prescribe.

Do I have advanced fibrosis?

Patients with cirrhosis have an increased risk of liver cancer and should undergo annual screening.

Should I be tested for other autoimmune diseases? 

Have I had testing for other autoimmune diseases, including celiac disease and thyroid disease? Up to 50% of AIH patients will develop other autoimmune diseases. 18% of AIH patients will develop autoimmune thyroid disease, and 5% of AIH patients will develop celiac disease. Both diseases are easy to screen for with blood tests.

Do I need a yearly skin exam?

Immunosuppressants used for the treatment of AIH have been shown to slightly increase the risk of non-melanoma skin cancer.

Do I need a bone density test?

Bone density testing should be considered in all AIH patients and every two to three years in adult patients with ongoing risk factors (>65 years old, post-menopausal, long-term use of steroids, history of fractures) for osteoporosis.

Should I take a Vitamin D supplement?

Low Vitamin D levels have been associated with harder-to-control inflammation in AIH, as well as bone loss. Many AIH patients take a Vitamin D supplement.

Should I receive additional vaccines? 

Am I up to date on all relevant vaccinations, including the COVID-19 vaccine? Patients should receive the hepatitis A and B vaccine before starting immunosuppressive medication. Live vaccines (examples: MMR, varicella, MMRV, LAIV, yellow fever, Ty21a oral typhoid, BCG, smallpox, and rotavirus) are not recommended for those on high doses of immunosuppression, but exceptions exist. More information can be found here.

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Am I up to date on all routine health screenings?

Be sure to speak to your doctor about what screenings are recommended for you. 

 

Questions for Your Doctor