Paradoxical Tuberculosis Immune Reconstitution Inflammatory Syndrome (TB-IRIS) Treatment Trial

Inclusion Criteria: * HIV-1 infection documented by any locally licensed ELISA or rapid HIV test kit. * Age \>18 years * Paradoxical TB-IRIS diagnosed by case definition (see section 5.2) * Ability and willingness of the participant or legal guardian/representative to give informed consent. Receiving appropriate ART and anti-TB therapy, as judged by the site investigator Exclusion Criteria: * Inability to take oral medication; * Receiving chemotherapy, immunosuppressant, corticosteroid, NSAID, or statin medications; (ASA is acceptable) * Cannot or unlikely to attend regular clinic visits; * Known allergy to NSAIDs, statins or corticosteroids; * Liver transaminase \> 2 times the upper limit of normal within 60 days of enrollment; * History of myositis/myopathy; * High Investigator Suspicion of anti-TB treatment failure due to TB-resistance or medication non-adherence; * Receiving ongoing azole anti-fungal for treatment or secondary prophylaxis of cryptococcosis, histoplasmosis or penicilliosis; * Serious co-morbidities, co-infections, or laboratory values who should not receive NSAIDs, steroid or statins, as judged by the site investigator; * Minimal IRIS reaction which is unlikely to require treatment, as judged by the site investigator; * Pregnancy (a negative urine pregnancy test at screening is required for women of childbearing potential) or breast feeding; * Receiving a HIV treatment regimen containing a protease inhibitor at study entry. Exclusion for Randomization A Only * Life threatening TB-IRIS, as defined by: * Acute respiratory failure; PaO2 \< 60 on room air or; * Altered mental status or; * New focal neurological deficit or; * Compression of the vital organs. * Persons with uncontrolled diabetes mellitus; * Impair kidney function, glomerular filtration rate \<60 ml/min; within 72 hours of consent * Uncontrolled congestive heart failure * History of bleeding disorder; * Platelet count \<100,000/µL; * History of significant gastrointestinal bleeding or ulceration; * Prior adjunctive corticosteroid therapy for this TB episode for \> 48 hr; * Pregnancy