TNF and metabolic syndrome: Even though the underlying mechanism is not fully understood, it has been postulated as multifactorial, including a combination of elevations in circulating inflammatory mediators that induce both metabolic syndrome and immune reconstitution inflammatory syndrome, which can further modulate lipid metabolism (such as IFN-α and TNF), impaired TG clearance, and enhanced abnormal fat distribution in addition to the effects of individual ART (6, 15–18).