Our hypothesized determinants of significant fibrosis were modifiable risk factors associated with liver disease progression, hepatic fibrosis, or hepatotoxicity, including immune dysfunction (i.e., CD4 T lymphocyte count <200 cells/mm3, HIV viremia) [11], diseases associated with hepatic steatosis (e.g., obesity, diabetes mellitus) [12-14], and ART use [15,16]. The gene discussed is CD4; the disease is obesity due to melanocortin 4 receptor deficiency.