Autoimmune diseases and immune-mediated inflammatory diseases may also be encountered in patients receiving ART (49) and many appear to be immune reconstitution disorders. Pathogenic mechanisms, however, are distinct from those in an IRIS associated with HIV-related infections or cancers. Psoriasis, sarcoidosis, rheumatoid arthritis, ankylosing spondyloarthritis, Graves’ disease, autoimmune hemolytic anemia, immune thrombocytopenia and inflammatory bowel disease are most common whereas systemic lupus erythematosus and multiple sclerosis are rarely encountered. Graves’ disease is encountered most often in patients who commence ART at very low CD4+ T cell counts and, in contrast to an IRIS, presents at a median time of 21 months after starting ART (13). It appears to be a consequence of an acquired disorder of central immune tolerance (50). Sarcoidosis may present in HIV patients not receiving ART but is much more common after commencement of ART. It is also more common in patients who have received interferon-alpha or interleukin-2 therapy. Taken together, these characteristics suggest that sarcoidosis in HIV patients is the result of an acquired disorder of immune regulation that leads to a granulomatous inflammatory response against unknown antigens. From a clinical perspective, it is important to differentiate sarcoidosis from an IRIS associated with infection by mycobacteria or fungi, which may also present with granulomatous tissue inflammation (13). Sarcoidosis in HIV patients may affect various body sites including lungs, lymph nodes and skin.