Type 1 reactions can occur in leprosy patients with oral corticosteroids being the drug of choice for treatment. However, in the setting of immunocompromised state (i.e., HIV), chronic steroid use poses significant risks, including opportunistic infections, highlighting the need for non-immunosuppressive alternatives. We report a case of Type 1 lepra reaction in a PLHIV patient with leprosy, previously on oral steroids, who was successfully treated with short-course high-dose clofazimine.