These include direct effects of the virus on osteogenic cells, ongoing activation of pro-inflammatory cytokines, particularly tumor necrosis factor alpha (TNFα) and interleukin−1, alterations in vitamin D metabolism leading to a deficiency in 1,25-dihydroxyvitamin D, and mitochondrial abnormalities associated with lactic acidosis and the onset of opportunistic infections [5]. Here, TNF is linked to lactic acidosis.