TNF and obesity due to melanocortin 4 receptor deficiency: In individuals with obesity, prolonged viral persistence and an exacerbated inflammatory response, characterized by elevated levels of pro-inflammatory interleukins (e.g., IL-1β and IL-6), anti-inflammatory cytokines such as IL-10, tumor necrosis factor (TNF), and altered adipokine secretion, contribute to additional disruption of RAAS signaling, amplifying Ang II-mediated effects (5, 20).