In our cohort of TB/HIV patients, only four of 33 (12.1%) patients developed paradoxical IRIS after cART initiation despite their severe immunodeficiency (median CD4+ T cell absolute count: 57 cells/mm3; IQR: 17–144), and high HIV viral loads (median: 5.64 Log10 copies/mL; IQR: 5.22–5.88) at study inclusion, besides the early initiation of cART after starting TB therapy, which are considered significant risk factors for IRIS development (53, 54). Here, CD4 is linked to Immunodeficiency.