Professor C. Rinaldi A. Lesmana introduced the management of patients with cirrhosis and AIH without cirrhosis in the Department of Hepatobiliary Diseases of The General Hospital of Indonesia. The reporter of Hepatology Digest interviewed Professor Lesmana about the related issues. The interview contents are as follows.
<Hepatology Digest>: How do you assess the severity of autoimmune hepatitis in routine clinical practice?
Dr Lesmana: Autoimmune hepatitis is quite a rare disease in Indonesia. It is not easy to assess, and usually we need to use liver biopsy. For most people, performing liver biopsy is a problem, so we assess severity using non-invasive assessment such as FibroScan. However, a liver biopsy will show with certainty that the diagnosis is correct prior to initiating treatment for autoimmune hepatitis. For monitoring and follow-up, looking at liver fibrosis improvement as a non-invasive assessment is done.
<Hepatology Digest>: What is the mechanism of autoimmune hepatitis?
Dr Lesmana: The mechanism is similar to other liver diseases, with cytokines causing inflammation. But one thing we are still curious about with the increase in autoimmune hepatitis in our country is the role of drug-induced disease (due to antibiotics or herbal supplements). In countries like Indonesia, India and China, herbal supplements are often used in daily life. We are unsure of the role, but with incidences increasing, we are concerned. Genetically, it is a very rare disease for Asian and South Asian populations. Currently, we don’t know the exact prevalence, but in my clinical practice, it is increasing.
<Hepatology Digest>: Can you talk about progress in the treatment of autoimmune hepatitis?
Dr Lesmana: We still use steroid-based treatment, sometimes in combination with other immunosuppressants, to reduce the side effects of the steroids in the longer term. In our experience, results are quite good, but there are still some patients who progress to liver cirrhosis. In our small study experience, we can show that even patients with liver cirrhosis due to autoimmune disease tend to see improvements once diagnosed, even with decompensated liver cirrhosis, when treated with low-dose steroids. They see improvement in ascites and bilirubin levels. It is only a small number of patients in our study, but it has been an opportunity to show that even in patients with decompensated liver cirrhosis, it is useful to use standard basic steroid therapy.
<Hepatology Digest>: Hepatology Digest is a Chinese journal, and, of course, our Chinese hepatologists are not attending this meeting. What has the meeting done to try to accommodate those who cannot be here in Indonesia?
Dr Lesmana: We have been quite desperate, because it is not just the Chinese faculty who have been unable to attend, but other countries facing similar issues with travel, such as South Korea and Japan. Over the last two weeks, we have been working hard to set up teleconferencing between countries. Today, we have already had a teleconference with Singapore, Japan and India, which allows for two-way interactions. During the main symposium, there will be a session for the Chinese doctors where there will be a teleconference presentation involving members of the invited faculty.
<Hepatology Digest>: If you could address our Chinese hepatologists, what words of encouragement would you give to them?
Dr Lesmana: Firstly, I would share my deep regret for events in China. Secondly, as this is now no longer a China-only issue, and because we are all doctors in our respective societies, this is now everybody’s problem. I encourage them not to give up when tackling these problems. We have many other severe diseases we need to address as well. In Indonesia, the case fatality rate of dengue fever is still higher than that of the coronavirus. That is part of our lives. We have to move forward doing our job as usual and as best we can. I am surprised today to see faculty members from Japan, Turkey, the Philippines, European countries, and the United States in attendance, and they are here to support this meeting. We are all friends and try to support each other. We understand the underlying conditions, and appreciate each other, and aim to accommodate everyone who wishes to contribute.
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