BACKGROUND: Tuberculosis (TB) remains the leading cause of illness and death among people living with HIV (PLHIV), particularly in high-burden areas. This study examined associations between TB and routine clinical markers: serum cholesterol, platelet count, and CD4 cell count. SETTING: The analysis included data from the TREAT Asia HIV Observational Database, a multicenter cohort of adult PLHIV receiving care across the Asia-Pacific region. METHODS: The authors conducted a cross-sectional matched case-control study of prospective and retrospective patients with TB, comparing clinical and laboratory data within ±3 months of TB diagnosis. Conditional logistic regression assessed associations between TB and covariates. RESULTS: The analysis included 4244 PLHIV from 20 sites: 1427 patients with TB and 2817 matched controls. Patients with TB were predominantly male (75.3%) and 45.7% aged 31-40 years. Multivariable analysis showed greater odds of TB diagnosis among males, those with low BMI, prior AIDS diagnosis, high HIV viral load, low CD4 + counts, or low total cholesterol. CD4 + counts <200 cells/μL had higher TB odds (adjusted OR [aOR] 12.90, 95% CI: 8.84-18.82) than CD4 + >500 cells/μL. Cholesterol <3.9 mmol/L had higher TB odds (aOR 3.11, 95% CI: 1.94 to 4.98) than cholesterol >5.5 mmol/L. CONCLUSIONS: In this Asia-Pacific cohort of adults living with HIV, low CD4 + cell count and low total serum cholesterol were associated with increased TB odds. Cholesterol may represent a low-cost adjunct marker to support TB risk stratification in PLHIV in endemic settings, but requires validation and evaluation of feasibility and cost-effectiveness. Copyright © 2025 The Author(s). Published by Wolters Kluwer Health, Inc.