Great progress has been made over the past few years in HIV testing in patients who have tuberculosis (TB) and in the scale-up of antiretroviral therapy. More than 3 million people in resource-limited settings were estimated to have started antiretroviral therapy by the end of 2007 and 2 million of these were in sub-Saharan Africa. However, little is known about what impact this massive public health intervention will have on the HIV-associated TB epidemic or how antiretroviral therapy might be used to best effect TB control. This article provides an in-depth review of these issues.