Thus, our data suggest that the increased levels of circulating sEV-carried miR-20a-3p and decreased miR-186 and miR-324-5p associated with HIV lipodystrophy might influence adipocyte differentiation in several key ways, by affecting pathways related to lipid catabolism, inflammation, or cellular adhesion, among others, through effects on Ltbp2, Nebl, and Wisp2. Here, NEBL is linked to lipodystrophy.