Alcohol abuse is also awell-established risk factor for ALT elevations.20 In a study by Pol et al, HIV-infected patients who consumed <40 g/d of alcoholwere at risk of alcohol-associated hepatitis, suggesting that HIV-infected patients may bemore sensitive to alcohol toxicity.7 This is consistent with our finding that individuals who consumed alcohol had 3 timesthe risk of severe ALT elevations. Here, GPT is linked to alcohol abuse.