Title: Association Between Aflatoxin B1 Albumin Adduct Levels and Tuberculosis Infection Among HIV+ Ghanaians. Background: Aflatoxin exposure has been shown to cause cell-mediated immune suppression and enhance HIV viral replication. Such immune suppression from aflatoxin can impair resistance to both infectious diseases and chronic infections. Methods: Hazard ratios (HRs) with 95% confidence intervals (CI) and a test for trend for opportunistic infections OI) among 141 HIV positive Ghanaians based on quartiles of aflatoxin B1 albumin adduct levels (AF-ALB) were calculated. Findings: HRs were significantly higher for developing symptomatic TB (HR 3.30, 95% CI 1.34-8.11) for those in the highest AF-ALB quartile compared to the lowest. Significantly higher HRs were not observed for other infections investigated. Conclusions: Those with the highest levels AF-ALB from dietary intake have an increased hazard of symptomatic TB but not malaria, HBV, or pneumonia. © Under License of Creative Commons Attribution 3.0 License.