The association between a shorter delay between TB treatment initiation and ART initiation is an area of debate. While some investigators have found no difference in time from TB therapy to initiation of ART between IRIS and non-IRIS subjects [30] , others have reported a significant differences between groups [31, 35] . In general, IRIS occurred in subjects initiated on ART within two months of TB therapy initiation [35] . Based on these and other data, a decision analysis on ART initiation timing in TB patients found the highest rates of IRIS occurred in patients initiated on ART within two months of TB therapy initiation [44] . However, withholding or deferring ART until two to six months of TB therapy was associated with higher mortality in scenarios where IRIS-related mortality was less than 4.6%. Future reports from large, prospective observational cohorts may aid in resolving this difficult issue.