Most previous studies on smoking and tuberculosis (TB) have not considered the role of human immunodeficiency virus (HIV) infection, and very few have been conducted in sub-Saharan Africa. We conducted a case-control study on smoking and TB in Addis Ababa, Ethiopia. Men aged 18-65 years with TB (n = 72) were compared to men with no history of TB (n = 81). Forty-three per cent of cases smoked vs. 25% of controls (OR 2.3, adjusted for age, education and self-reported HIV status). Given that HIV appears to increase TB transmission in Africa, our finding that smoking also increases the risk of TB in Africa is of special concern.