After starting anti-tuberculosis treatment, some patients develop an exacerbation of symptoms, signs or radiological manifestations of TB. This has been well described in patients without HIV infection, but appears to occur more commonly in HIV-positive patients . The phenomenon is known as IRIS, IRD or paradoxical reaction. The aetiology of these reactions is unknown, but they are presumed in HIV disease to occur at least in part as a consequence of HAART-related reconstitution of immunity, which leads to an abnormal immune response to tubercle antigens released by dead or dying bacilli.