This is a process whereby free reactive oxygen species (ROS) provoke increased activation of Kupffer cells in the liver. In turn, these activated immune cells promote stellate cell activation via nuclear factor kappa-beta (NF-kB) and activator protein 1, leading to increased production of proinflammatory and profibrotic cytokines, resulting in liver damage, fibrosis, and cirrhosis. Nucleoside reverse transcriptase inhibitors (NRTIs) such as didanosine can cause oxidative stress and mitochondrial toxicity. Here, NFKB1 is linked to Cirrhosis.