After starting HIV treatment and experiencing an improvement in their immune system, about 25% of people who have had TB, experience a temporary worsening of TB symptoms. A chest X-ray might show worsening of TB in the lungs. Symptoms include fever and swollen glands, which can turn into pus-filled abscesses. These will go away given time, but they need expert management.

It is not normally necessary to change HIV treatment or to restart TB therapy. Sometimes a drug called prednisolone is used to control the immune reaction.

It seems that people who started HIV treatment with a CD4 cell count below 100, and within two months of starting an anti-TB drug combination, are at greatest risk of experiencing this.  If you are concerned about any aspect of starting treatment, including the possibility of developing this syndrome, ask your doctor to spend some time talking to you about it and answering any questions you have.