Despite various anti-tuberculosis measures in the setting of HIV infection, the epidemiological situation of tuberculosis in Russia is deteriorating. We have analyzed the data of statistical report form no. 61 for years 2004–2014, surveillance data on individual TB cases with HIV coinfection for years 2004–2014 (personal data) and TB care arrangements for patients with HIV in 20 regions. The main causes of the deteriorating epidemiological situation are the growing immunodeficiency in patients with TB coinfection, unseparated epidemiologically dangerous patient flows (patients with tuberculosis and HIV-infected patients) and low quality preventative measures in special care medical facilities. Chemoprophylaxis can be an effective method of controlling the spread of tuberculosis among HIV-infected patients if it is recommended by a qualified tuberculosis therapist to patients adhering to regular drug intake under supervision of medical personnel. Otherwise a large scale chemoprophylaxis can result in an increased proportion of patients with drug-resistant tuberculosis. This works suggests criteria for the evaluation of tuberculosis care effectiveness considering the pathogenesis of the disease during late stages of HIV.