TNF and fatty liver disease: The presence of HCV in the cells results in oxidative stress due to the increase of cell metabolism, with the reduction of antioxidant enzymes and the increase of liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST).[1] HCV carriers exhibit high levels of proinflammatory cytokines, such as tumor necrosis factor alpha (TNF-α), which inhibit insulin signaling in the hepatocytes, and thus increase the risk of insulin resistance and hepatic steatosis.[2]