TNF and tuberculosis: IRIS is thought to result from rapid but dysregulated restoration of antigen-specific immunity during early ART.4 In paradoxical TB-IRIS this results in inflammation at the sites of TB disease directed at the residual MTB antigen.5 In addition, TB-IRIS has been shown to be accompanied by marked cytokine elevation in peripheral blood, in particular the pro-inflammatory cytokines IL-6, TNF-α and IFN-γ.6