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Background: Tuberculosis (TB) is the most common opportunistic disease in human immunodeficiency virus (HIV)-positive persons. Methods: We prospectively studied the clinical, radiological, cytological, histopathological and microbiological presentation of TB in HIV-positive patients and occurrence of immune reconstitution inflammatory syndrome (IRIS) in HIV TB co-infected patients. Results: Out of 70 patients studied, 47 were male. Fever was the most common symptom (n = 61, 87.1%). The most common laboratory finding was anaemia (n = 67, 95.7%). In 32 (45.7%) patients presenting with TB, HIV infection was diagnosed. A CD4+ count <200/mm3 was seen in 57 (81.4%) patients. Extra-pulmonary TB (44.3%) was more common than pulmonary TB. All patients were started on anti-TB treatment; 6 had developed IRIS. Conclusions: Our observations suggest that screening all HIV-seropositive patients for TB and careful monitoring for the occurrence of IRIS while on anti-TB treatment are helpful in managing HIV HIV-TB co-infected patients.