The Italian Cohort Naive Antiretrovirals (ICONA) study showed that, in PWH, increased tumor necrosis factor-a (TNF-a) was associated with a 13-fold increased risk of having a fibrosis-4 (Fib-4) index score higher than 1.45, indicating advanced fibrosis and potentially cirrhosis [8]. Here, TNF is linked to Cirrhosis.