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Lemoine et al’s excellent article from the Gambia reported on non-invasive markers of liver fibrosis in patients with chronic HBV infection. 1 They propose a novel biomarker—the gamma-glutamyl transpeptidase (GGT) to platelet ratio (GPR)—as a routinely available test that could identify patients with fibrosis or cirrhosis in resource-limited settings, thereby informing prognosis and guiding monitoring. Notably, the study excluded patients with conditions that might predispose to altered GGT or platelet counts, including pregnancy, significant alcohol consumption, use of antiviral therapy, acute malaria and hepatitis C, hepatitis delta or HIV coinfection. In their letter, Boyd and colleagues subsequently reported that in a French HBV/HIV coinfected cohort, GPR showed reasonable performance for identifying significant liver fibrosis. 2 HBV and HIV are highly co-endemic in West Africa, and chronic liver disease is an …