Mechanisms involved are increased biliary saturation secondary to increased cholesterol mobilisation, increased nucleation because of changes in bile arachidonate and glycoprotein concentrations, and elevated levels of mucin and calcium in bile.32 Therefore, overall BMI may not be an accurate risk stratifying tool in the development of gallstones in PLWH who may well be going through weight cycling type of phenomenon. Here, ART4 is linked to gallstones.