In a developing country, 289 patients were examined for active pulmonary mycobacterial disease (sputum smear and culture) and HIV infection (serology) to compare the sensitivity and positive predictive value of sputum smears for diagnosing pulmonary tuberculosis in patients with and without antibodies to HIV. Seventy-nine percent of HIV-seronegative vs 66% of HIV-seropositive patients with positive cultures for Mycobacterium tuberculosis were smear positive (P less than .05), and a positive sputum smear predicted the presence of M. tuberculosis in 90% of HIV seronegative vs 80% of HIV seropositive patients (P less than .05). In our opinion, HIV did not significantly compromise the diagnostic utility of the sputum smear.