However, several factors have been identified which include HIV infection, ART, the genetic background, and host metabolic factors.[7–9] The development and severity of HALS have been initially associated with the duration of HIV infection, and low CD4+ T cell count.[10,11] More recently, Lo et al[12] first reported on contribution of cumulative exposure to ART as one of the strongest factors for dyslipidemia, especially with protease inhibitors (PIs). Here, CD4 is linked to metabolic syndrome.