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. A chest x-ray might show worsening of TB in the lung. Symptoms include fever and swollen glands, which can turn into pus-filled abscesses. These need expert management.

It is not normally necessary to change HIV treatment or to restart TB therapy. Sometimes a drug called prednislone 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.