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Many cases start after an infection such as EBV, West Nile, or COVID-19, while others follow immune stressors like mold or mycotoxin exposure, yet they converge on similar longlasting fatigue and pain
Bile acids (BAs) are considered microbiota-derived signaling metabolites, and dysregulation of BA-hepatic metabolic interactions is strongly linked to both NAFLD and hepatocellular carcinoma (HCC) 32

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The presence of cirrhosis before treatment was determined by liver biopsy examination showing cirrhosis (METAVIR stage 4), or a liver stiffness measurement of more than 12.5 kPa (transient elastography)
