Macrophage migration inhibitory factor (MIF) activates macrophages, promotes delayed-type hypersensitivity reaction, and regulates Th1/Th2 balance in inflammatory response. Serum MIF concentration is high in patients with pulmonary tuberculosis (PTB). Higher MIF levels are associated with high mortality. No study has addressed MIF levels and its role in PTB/HIV-co infection. We determined serum and BAL MIF levels in Tanzanian HIV-infected patients with and without PTB, and correlated the levels with 1-month outcome. We compared with serum MIF levels of HIV seronegative patients with PTB and of healthy controls. All HIV-infected patients irrespective of PTB infection had significantly higher serum MIF levels than HIV-seronegative patients with PTB, and than healthy controls. In HIV seropositive patients low serum MIF levels were associated with high 1-month mortality. In conclusion, HIV infection was associated with elevated serum MIF levels regardless of PTB. Low serum MIF levels were associated with high mortality.