CD4 and obesity due to melanocortin 4 receptor deficiency: Obesity is thought to be associated with a chronic inflammatory state in the adipose tissue which is mediated through a number of inflammatory signals/cells [e.g., M1 macrophages, inflammatory cytokines (TNF-alpha and IL-6), and activated CD4+ and CD8+ T cells] (35), HIV/ART further exacerbate this condition through further modulation of inflammatory cytokines and mitochondrial dysfunction (36).