Abstract
We thank Stian Orlien and colleagues for raising attention to the issue of khat use as a recreational drug in sub-Saharan Africa in response to our Comment.1 Although we mentioned the fact that traditional herbal medicine could contribute to the burden of cirrhosis in this region, as the use of khat is associated with a substantial increase in liver fibrosis,2 we do not think that the available evidence shows that khat is a major contributor to chronic liver disease. Khat is used in parts of east Africa, including Djibouti, Ethiopia, Somalia, Somaliland, Kenya, Sudan, Uganda, and Madagascar.