Autoimmune Hepatitis: Diagnostic and Management Challenges in 26 Cases in Libreville, Gabon

Introduction: Autoimmune hepatitis (AIH) is a chronic immune-mediated inflammatory liver disease, rarely described in sub-Saharan Africa where chronic viral hepatitis B and C predominate. This study aimed to describe its epidemiological features and management challenges in Libreville. Materials and Method: A retrospective observational study was conducted from January 2023 to October 2025 at the Libreville University Hospital. Epidemiological, diagnostic, and outcome data were collected from patients followed for AIH. Statistical analysis included univariate analysis (Fisher’s exact test, Mann-Whitney) and multivariate penalized logistic regression, with significance set at p < 0.05. Results: Among 256 patients followed for chronic liver disease, 26 had AIH (10.15%). Mean age was 34.5 ± 11.7 years, with female predominance (69.2%). Formal immunological subtyping was achieved in only 8 patients (30.8%) because of limited access to autoantibody testing. Among these patients, AIH type 1 was the most frequent subtype. Liver histology was accessible in only 19.23% of patients due to severe coagulation disorders. Five deaths were recorded (19.23%) despite corticosteroid therapy in all patients. On univariate analysis, factors associated with mortality included PT < 50% (p = 0.053), elevated bilirubin (OR = 36.0; p = 0.006), ascites (OR = 76.0; p = 0.002), and esophageal varices (OR = 28.5; p = 0.016). On multivariate analysis, three independent predictors of death were identified: PT < 50% (OR = 1.98; p = 0.012), elevated bilirubin (OR = 2.83; p = 0.024), and ascites (OR = 3.59; p = 0.022), with an AUC of 0.935. Conclusion: AIH represents a significant cause of chronic liver disease at the Libreville University Hospital, predominantly affecting young women and associated with high mortality related to late diagnosis.