HIV and tuberculosis (TB) are leading global causes of mortality and morbidity. Highly active antiretroviral therapy (HAART) is often initiated in patients being treated for TB. The immune recovery associated with HAART results in dramatic clinical benefits, but this restoration of immunity may result in immunopathological reactions. The immune reconstitution inflammatory syndrome can result in fever, nodal enlargement, and worsening pulmonary infiltrates observed on a chest radiograph, with or without recurrent respiratory symptoms. Several other manifestations have also been described. As a consequence, the use of HAART might not be appropriate during the first weeks of anti-TB therapy in HIV-infected patients. In this review, we summarize the incidence, clinical presentations, and potential mechanisms of these conditions and we describe therapeutic methods.