Sarcoidosis is a multisystem granulomatous disorder characterized pathologically by the presence of noncaseating granulomas in involved organs (41).   The disease is characterised by bilateral hilar adenopathy, pulmonary infiltrates and possible involvement of the skin, joints, or eyes. The diagnosis of sarcoidosis is established based on compatible clinical and radiologic findings supported by histologic evidence in one or more organs of noncaseating epithelioid-cell granulomas in the absence of other causes (42).   It is important that other causes of granulomatous inflammation such as infection are excluded before a diagnosis of Sarcoidosis can be made, particularly in the patient with HIV infection (43). Evidence suggests that sarcoidosis results from environmental triggers and a susceptible genetic host (41).  

Sarcoidosis has been described in HIV patients both before and after the advent of highly active antiretroviral therapy (HAART) (42).   A case series from France examined 11 subjects with sarcoidosis. Most were diagnosed after the commencement of HAART but in 3 cases, sarcoidosis was diagnosed prior to starting HAART. The manifestations in those with HIV were like those described in patients not infected with HIV (44).  Most of the subjects in this case series had a CD4 cell count above 200 cells/mm3. One patient had received IL-2 prior to the diagnosis of sarcoidosis, and one had received IFN-a therapy for chronic Hepatitis C. Other studies have emphasised the relationship of higher T cell counts to the diagnosis of sarcoidosis (45). Furthermore, other explanations for granulomatous inflammation such as infection are more likely to be found in HIV-infected patients with peripheral CD4+ lymphocyte counts of < 200 cells/ mm3 (46). 

The development of pulmonary sarcoidosis has been described as part of the Immune Reconstitution Inflammatory Syndrome (IRIS) following commencement of HAART (47). Likewise, symptoms and signs of previously diagnosed sarcoidosis may flare after the commencement of HAART (45). Clinicians should be aware of this possibility when commencing HAART in such patients.  Management of sarcoidosis in HIV-infected persons should follow established guidelines for non-HIV-infected persons (41).