TNF and Kaposi's sarcoma: Primary gonadal failure was attributed to opportunistic infections such as (Cytomegalo virus, Mycobacterium avium complex, Cryptococcus neoformans etc) infiltration by a neoplasm like Kaposi’s sarcoma, IL 1 and tumor necrosis factor (TNF) that decreases the leydig cell steroidogenesis [52, 53].